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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 4 4 2.732540 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.033333 $1.6200 $48.4500
EXIT -EXIT EXIT ASSESSMENT 21 21 3.563624 $178.1800 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 21 22 3.596957 $179.8000 $49.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.400000 $2000.0000 $5000.0000
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
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 115.714286 $2892.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 24 24 117.336507 $5866.8100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 24.785714 $1682.4500 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 3 3 16.642857 $1129.7200 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 64.857143 $4402.5100 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 19 24 6078.904763 $3039.4500 $0.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 101 211 6649.226982 $32495.8500 $4.8900
-------------------------------------------------------------------------------------------------------------------------------------
Total 237 6655.556479 $32675.6500 $4.9100
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 121