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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2250 FSPSA's found
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 1 1 0.038889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.038889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 24 24 4.054111 $196.6200 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.005479 $0.1200 $22.0300
EVAL -96111 DEVELOPMENTAL EVALUATION 6 7 0.616439 $30.8200 $49.9900
EXIT -EXIT EXIT ASSESSMENT 60 60 13.662178 $683.1000 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.333333 $25.0000 $74.9900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 0.010959 $0.6000 $55.1900
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 36 36 0.246104 $18.5000 $75.1800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 0.035615 $2.6800 $75.1800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 47 47 0.247928 $13.8000 $55.6600
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 6 6 0.030135 $2.2700 $75.1600
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.104110 $5.3100 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.101370 $5.1800 $51.0700
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 2 2 0.389041 $58.3500 $149.9800
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.322222 $16.4500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 0.490411 $25.0300 $51.0500
SCREEN-T1023 SCREENING 7 8 1.553119 $77.6600 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.333333 $17.0200 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.024658 $1.2400 $50.0900
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Subtotal (Total Children Is Unduplicated) 150 210 22.566024 $1180.1500 $52.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 10 2.375952 $11880.0000 $5000.1000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.041096 $2.0600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 68 80 13.159715 $657.9400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 4.269406 $106.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 189 376 563.878389 $28193.9900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 4 8.866666 $221.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.050000 $2.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 14 14 9.366668 $468.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.233333 $55.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 11 403.285713 $10082.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 40 40 169.773012 $8488.6600 $50.0000
INTR -T1013 INTERPRETER 18 25 10.690739 $534.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 325 566 1958.679852 $19586.7900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 11 77.285714 $5521.3000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 16 17 122.214285 $8731.0000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 44 46 336.999998 $24075.3000 $71.4400
TRAV -TRAVS Travel by mile 364 833 97765.136159 $43505.5000 $0.4500
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Subtotal (Total Children Is Unduplicated) 397 2039 101448.306697 $162114.3000 $1.6000
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Total 2250 101470.911610 $163294.4500 $1.6100
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Number of Children (Unduplicated) With at Least One Authorization 413