Summary Report for FSPSAs Ending During the Report Period Statewide
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: 07-01-14 and 09-30-14 Date of Report: 11-19-14 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 3 3 2.511111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 2.511111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.088889 $4.3100 $48.5100
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 2 2 0.238889 $14.9600 $62.6300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.072222 $1.7700 $24.5400
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 9 9 1.394444 $67.6300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.172222 $8.3500 $48.4900
PSTH -97001 EVAL BY LICENSED PT, INITIAL 9 9 1.244445 $60.3600 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 28 28 4.000004 $194.0200 $48.5000
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Subtotal (Total Children Is Unduplicated) 45 52 7.211115 $351.4000 $48.7300
EI Services, Class # 03
CONIF -CONIF CONSULT ITDS, FACE TO FACE 27 27 11.794446 $589.7300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 42 42 27.276192 $1363.8200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 31 31 14.750000 $737.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 137 138 63.680957 $3184.0700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 80 80 221.715873 $11085.7900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 12 26.390476 $1791.3800 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 0.800000 $43.4600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 19 19 52.566665 $3568.2100 $67.8800
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 3 3 4.023810 $201.1900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 41 42 98.830951 $6708.6600 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 10.285714 $135.7700 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 342 504 1427.303970 $14273.0400 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 32 68 3167.380159 $1583.6900 $0.5000
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Subtotal (Total Children Is Unduplicated) 435 969 5126.799213 $45266.3000 $8.8300
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Total 1024 5136.521439 $45617.7100 $8.8800
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Number of Children (Unduplicated) With at Least One Authorization 445