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: 07/01/08 and 09/30/08 Date of Report: 11-18-08 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
CASE -CASE NON-TCM CASE MANAGEMENT 2 2 1.43 $52.83 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 270 270 264.86 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 22 26 28.00 $1036.00 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 15 15 16.81 $621.92 $37.00
TCON -TCON TRANSITION CONFERENCE 1 1 1.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 305 314 312.10 $1710.75 $5.48
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 47 49 52.15 $2529.40 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.00 $108.21 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 105 108 108.00 $1146.96 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 102 105 105.00 $927.15 $8.83
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 104 107 107.00 $1155.60 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 101 104 104.00 $2266.16 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 4 4 4.00 $217.52 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 97 99 99.00 $2799.72 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 198 214 238.59 $14315.47 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 24 26 30.09 $1408.16 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 134 136 155.61 $18610.71 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 2.00 $250.00 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 40 41 63.92 $7990.59 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 133 140 139.23 $6961.67 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 93 105 132.04 $6601.79 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 20 20 20.00 $600.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 2.56 $192.08 $75.00
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 1.50 $83.25 $55.50
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 20 20 26.86 $2014.28 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.00 $150.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 12.27 $920.42 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 26 26 33.00 $2475.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 58 59 76.86 $4265.57 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 20 20 23.50 $1304.25 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 507 507 707.36 $53051.79 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 122 124 183.00 $13725.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 158 160 238.53 $17890.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 473 486 726.36 $40312.82 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 484 540 743.43 $55757.14 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 1 1 1.00 $72.78 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 2 2 2.00 $300.00 $150.00
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 1.00 $50.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 1 1 1.00 $50.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 103 106 130.76 $6341.76 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 512 530 564.20 $27363.62 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 122 127 124.97 $6060.88 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 351 368 365.53 $17728.43 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 27 27 27.00 $1350.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1044 1104 1141.27 $55351.66 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 1.00 $100.00 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 8 8 8.00 $400.00 $50.00
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Subtotal (Total Children Is Unduplicated) 3238 5496 6508.59 $375199.83 $57.65
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 131 149 272.00 $408000.00 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.00 $68.86 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 100 105 185.81 $9290.48 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 679 1086 1888.56 $94428.22 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 32 36 38.63 $965.84 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1083 1188 2126.15 $106307.55 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 99 101 155.67 $3891.73 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 551 601 913.01 $45650.66 $50.00
CONOP -CONOP CONSULT, OT, PHONE 24 24 33.69 $842.23 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 396 416 699.72 $34985.85 $50.00
CONPP -CONPP CONSULT, PT, PHONE 19 20 29.31 $732.64 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1112 1204 1829.58 $91479.22 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 97 102 143.40 $3584.99 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 31 32 120.16 $8821.95 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 11 11 1016.71 $12708.93 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 3 3 4.97 $124.17 $25.00
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 1.77 $44.17 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 267 310 1631.34 $40783.57 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 9 166.57 $8328.57 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 4 4 13.00 $650.00 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 18 18 108.14 $5407.14 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 22 22 118.80 $5940.24 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 8 8 57.23 $1430.71 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3155 3573 22086.11 $1104305.41 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 16 17 92.95 $4647.38 $50.00
INTR -INTR INTERPRETER 56 59 320.44 $16022.15 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 1831 2113 10355.42 $702925.80 $67.88
OCCT -97530HM OT SESSION BY OT ASST 142 148 766.01 $41609.81 $54.32
PHY -97110 PT SESSION BY LICENSED PT 1884 2153 10534.11 $715055.52 $67.88
PHY -97110HM PT SESSION BY PT ASST 124 130 801.67 $43546.93 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 23 23 20.11 $20.11 $1.00
SENS -FM FM RECEIVER HEARING AID 3 3 3.00 $4950.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 19 19 29.00 $14500.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 9 8.88 $381.92 $43.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 2.00 $228.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 8 8 12.00 $2845.44 $237.12
SENS -V5264 EARMOLD 42 44 64.01 $1198.21 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 46 58 160.41 $8020.72 $50.00
SIC -SIC SPECIAL INSTRUCTION CONSULTATION 2 2 11.43 $571.43 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3795 4361 23181.12 $1573534.32 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 9 62.57 $3398.88 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 263 281 1725.81 $22780.65 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 14 17 67.57 $6757.14 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2341 3285 233460.32 $116730.16 $0.50
VISN -T1024HN *EI VISION SERVICES, INDIVIDUAL 1 1 2.50 $125.00 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 66 84 331.47 $16573.64 $50.00
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Subtotal (Total Children Is Unduplicated) 7677 21850 315654.15 $5285196.30 $16.74
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Total 27660 322474.83 $5662106.88 $17.56
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Number of Children (Unduplicated) With at Least One Authorization 8835