Summary Report for FSPSAs Ending During the Report Period Center: 09
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: 01/01/08 and 12/31/08 Date of Report: 02-16-09 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
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 1100 1129 1735.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 1100 1129 1735.00 $0.00 $0.00
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 7 7.00 $339.50 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 3.39 $122.24 $36.07
AUDE -AUDE UNSPECIFIED AUDE SERVICES 3 3 2.11 $126.67 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 11 13.50 $631.80 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 11 13 15.00 $1794.00 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 15.00 $1875.00 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 18 18 18.00 $900.00 $50.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 1.00 $75.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 19 19.00 $1054.50 $55.50
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 3 3 3.00 $145.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 73 75 78.00 $3783.00 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 2.00 $97.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 32 32 32.00 $1552.00 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 28 31 55.36 $2684.82 $48.50
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 1.00 $50.00 $50.00
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Subtotal (Total Children Is Unduplicated) 179 219 265.36 $15231.03 $57.40
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 16 20 21.00 $31500.00 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 3.51 $241.77 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 2.98 $205.04 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 19 23 202.80 $10140.00 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 3.00 $150.00 $50.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 57 71 112.90 $5644.76 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 67 90 144.35 $7217.38 $50.00
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.00 $50.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 43 55.64 $2782.15 $50.00
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.00 $25.00 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 104 129 263.15 $13157.38 $50.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 40 43 328.93 $24149.95 $73.42
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 8.00 $200.00 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 23.86 $596.43 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 7 50.29 $2514.29 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 10 10 98.77 $4938.57 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 118 120 1850.92 $92545.95 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 617 943 12701.75 $635087.27 $50.00
HERN -T1024HN *EI HEARING SERVICES AFTER SHINE 2 2 10.14 $507.15 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 3 3 48.86 $2442.86 $50.00
INTR -INTR INTERPRETER 3 5 6.00 $300.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 844 1583 17418.01 $1182334.30 $67.88
OCCT -97530HM OT SESSION BY OT ASST 14 15 160.40 $8713.18 $54.32
PHY -97110 PT SESSION BY LICENSED PT 715 1235 16392.96 $1112754.41 $67.88
PHY -97110HM PT SESSION BY PT ASST 8 8 90.57 $4919.84 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 4 4 4.00 $4.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 12 15 17.00 $8500.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 12 12 12.28 $798.23 $65.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 3 3.13 $742.97 $237.12
SENS -V5264 EARMOLD 20 23 64.43 $1206.18 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 3 3 3.00 $150.00 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1608 2894 34381.33 $2333804.80 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 52.43 $2847.92 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 5 6 69.14 $912.69 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 1 2 27.00 $1350.00 $50.00
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Subtotal (Total Children Is Unduplicated) 2201 7332 84635.53 $5493434.44 $64.91
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Total 8680 86635.88 $5508665.46 $63.58
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Number of Children (Unduplicated) With at Least One Authorization 2220