Summary Report for FSPSAs Ending During the Report Period Center: 10
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 38 39 18.077776 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 38 39 18.077776 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -AUDE UNSPECIFIED AUDE SERVICES 11 12 7.722223 $463.3400 $60.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 19 19 8.466668 $410.6400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.688889 $33.4100 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 16 16 8.622223 $418.1800 $48.5000
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Subtotal (Total Children Is Unduplicated) 44 48 25.500003 $1325.5700 $51.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 0.511111 $2555.5000 $4999.8900
AUD -HA_FUP AUDIOLOGY SERVICES 1 1 4.071429 $203.5700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 130 161 113.389291 $5669.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 0.500000 $12.5000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 111 117 51.790482 $2589.5500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 76 84 46.405556 $2320.2800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 67 70 43.833331 $2191.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 200 212 104.555555 $5227.7800 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 22.933333 $573.3300 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 1.466667 $73.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 239 288 2038.755549 $101937.7500 $50.0000
INTR -INTR INTERPRETER 3 3 22.355555 $1117.7800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 80 88 392.822223 $26664.7800 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 92 100 407.883330 $27687.1000 $67.8800
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 162 175 812.466661 $55150.2000 $67.8800
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 715 1032 6003.671425 $60036.7100 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 38 42 373.914285 $186.9600 $0.5000
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Subtotal (Total Children Is Unduplicated) 879 2384 10441.325783 $294198.2500 $28.1800
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Total 2471 10484.903562 $295523.8200 $28.1900
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Number of Children (Unduplicated) With at Least One Authorization 924