Summary Report for FSPSAs Initiated During the Report Period Center: 10
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: 01/01/08 and 12/31/08 Date of Report: 02-16-09 Page: 1
Child has a MEDICAID # Filter: Y
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
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.00 $36.07 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 174 196 278.00 $2952.36 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 153 170 170.00 $1501.10 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 154 171 171.00 $1846.80 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 147 165 165.00 $3595.35 $21.79
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 140 156 156.00 $4411.68 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 139 196 321.07 $19264.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 21 33 33.00 $1544.40 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 25 29 42.00 $5023.20 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 30 42 42.66 $2132.78 $50.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.00 $75.00 $75.00
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Subtotal (Total Children Is Unduplicated) 310 1161 1381.72 $42409.84 $30.69
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 29 77.00 $115500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 27 42 195.71 $9785.49 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 143 181 245.50 $12275.00 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 1.00 $25.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2 2 2.00 $100.00 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 107 179 278.32 $13916.16 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 16 24 48.11 $2405.29 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 162 262 435.33 $21766.38 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.40 $60.00 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 17 23 302.93 $7573.34 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 2 2 2.19 $109.45 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 8.13 $203.33 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 289 600 5465.02 $273251.07 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 36 67 483.98 $24198.88 $50.00
INTR -INTR INTERPRETER 3 3 9.00 $450.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 314 613 4143.17 $281238.20 $67.88
OCCT -97530HM OT SESSION BY OT ASST 28 29 59.73 $3244.71 $54.32
PHY -97110 PT SESSION BY LICENSED PT 468 908 5950.09 $403891.77 $67.88
PHY -97110HM PT SESSION BY PT ASST 42 43 79.13 $4298.08 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 106 109 109.00 $109.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 3 5 10.00 $5000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 8 10 11.00 $715.00 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.00 $114.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 10 12 22.00 $5216.64 $237.12
SENS -V5264 EARMOLD 18 30 58.00 $1085.76 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 32 57 294.70 $14735.01 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 547 1059 7327.12 $497364.76 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.73 $202.79 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 43 46 109.63 $1447.16 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 22 66 396.03 $19801.66 $50.00
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Subtotal (Total Children Is Unduplicated) 1101 4406 26130.95 $1720083.90 $65.83
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Total 5567 27512.67 $1762493.74 $64.06
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Number of Children (Unduplicated) With at Least One Authorization 1141