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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2049 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 1.766667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 1.766667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 22 3.315680 $160.8200 $48.5000
EXIT -EXIT EXIT ASSESSMENT 54 54 34.930138 $1746.5100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 0.016437 $1.2400 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.010958 $0.8300 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 1.005479 $55.8100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 29 30 23.594515 $1769.6100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 8 8 4.032874 $302.4800 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 34 35 30.104104 $1670.7900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 15 15 10.047945 $753.6000 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.230137 $11.7500 $51.0400
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 6 6 2.343836 $119.6500 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 3 0.011036 $0.5600 $50.8800
SCREEN-T1023 SCREENING 4 5 0.793379 $39.6700 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.284932 $14.5400 $51.0400
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Subtotal (Total Children Is Unduplicated) 133 188 110.721450 $6647.8400 $60.0400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 7 1.987367 $9937.0000 $5000.0800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 56 63 17.394079 $869.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 5.040277 $126.0100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 163 191 321.781669 $16089.0900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 9.557143 $238.9300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 53 58 90.892856 $4544.6400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.666666 $66.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 30 50.533334 $2526.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.200000 $55.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 132 137 226.846845 $11342.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 6.733334 $168.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 45 47 261.757141 $13087.8500 $50.0000
INTR -T1013 INTERPRETER 10 16 62.964905 $3148.2500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 267 443 1764.969447 $17649.6600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 22 23 150.898414 $10780.1800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 17 17 116.000000 $8287.0500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 38 38 331.714287 $23697.6400 $71.4400
TRAV -TRAVS Travel by mile 342 773 114233.638680 $50833.9800 $0.4500
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Subtotal (Total Children Is Unduplicated) 366 1860 117657.576444 $173448.9400 $1.4700
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Total 2049 117770.064561 $180096.7800 $1.5300
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Number of Children (Unduplicated) With at Least One Authorization 394