Summary Report for FSPSAs Ending During the Report Period Center: 02
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs ending between: 10-01-13 and 12-31-13 Date of Report: 02-18-14 Page: 1
Eligibility Filter: Program Patients
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Service Coordination, Class # 01
SCONLY-SCONLY SERVICE COORDINATION ONLY 4 4 2.732540 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 2.732540 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 0.567122 $27.5000 $48.4900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 4 4 0.819483 $49.1700 $60.0000
EXIT -EXIT EXIT ASSESSMENT 23 23 3.760884 $188.0400 $50.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.282192 $13.6900 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2 2 0.277778 $13.4700 $48.5000
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Subtotal (Total Children Is Unduplicated) 33 35 5.707459 $291.8700 $51.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 6.633333 $33166.5000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 2 6.428572 $321.4300 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.944444 $23.6100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 44 48 66.231746 $3311.5900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 35 36 63.055555 $3152.7800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.944444 $23.6100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 11 19.199999 $960.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 47 47 73.780952 $3689.0500 $50.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 5 5 861.142858 $10764.2900 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 173.571429 $4339.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 130 132 733.856349 $36692.8300 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 5.142857 $257.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 43 43 260.271429 $17667.2300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.642857 $89.2400 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 45 45 242.185718 $16439.5400 $67.8800
PHY -97110HM PT SESSION BY PT ASST 2 2 11.785714 $640.2000 $54.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 65 65 461.890480 $31353.1300 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 5.428571 $71.6600 $13.2000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 19 24 6078.904763 $3039.4500 $0.5000
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Subtotal (Total Children Is Unduplicated) 219 474 9073.042070 $166002.5600 $18.3000
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Total 513 9081.482069 $166294.4300 $18.3100
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Number of Children (Unduplicated) With at Least One Authorization 232