Summary Report for FSPSAs Initiated During the Report Period Center: 02
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting between: 10-01-15 and 12-31-15 Date of Report: 02-12-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2941 FSPSA's found of which 43 had no frequency modifier field, FORCE FREQ MODIFIER to 0
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 33 42 12.745911 $618.1800 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 9 9 4.043533 $202.1700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 58 59 61.160467 $3058.0500 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 15 0.082185 $6.1900 $75.2900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 0.016437 $1.2400 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 33 34 0.180809 $10.0700 $55.6700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 6 6 0.028766 $2.1600 $75.0900
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.100000 $5.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 3 3 53.169222 $2714.2900 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.120548 $6.1500 $51.0300
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 46 48 15.279583 $2291.9700 $150.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.106849 $5.4600 $51.0700
SCREEN-T1023 SCREENING 8 9 2.288052 $114.4200 $50.0100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.142466 $7.2700 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.795151 $193.7400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.065753 $3.3600 $51.0900
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Subtotal (Total Children Is Unduplicated) 169 238 153.331211 $9240.1100 $60.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 9 12.323516 $61618.0000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 57 61 36.238885 $1811.9100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 6.690356 $167.2600 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 181 468 787.793351 $39389.7900 $50.0000
CONIP -CONIP CONSULT, PHONE 1 2 6.133334 $153.3400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 15 15 301.857141 $7546.4400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 98 114 804.639682 $40232.0400 $50.0000
INTR -T1013 INTERPRETER 13 19 37.154108 $1857.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 389 682 5554.409030 $55544.1000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 22 250.500000 $17895.7300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 15 18 133.285714 $9521.9300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 67 75 756.571422 $54049.5500 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 248 385 2087.697116 $1043.8500 $0.5000
TRAV -TRAVS Travel by mile 378 830 148977.551463 $66295.0200 $0.4500
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Subtotal (Total Children Is Unduplicated) 555 2703 159752.845118 $357126.6500 $2.2400
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Total 2941 159906.176329 $366366.7600 $2.2900
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Number of Children (Unduplicated) With at Least One Authorization 564