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
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 311 346 502.00 $5331.24 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 274 299 299.00 $2640.17 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 275 301 302.00 $3261.60 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 268 295 295.00 $6428.05 $21.79
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 248 271 272.00 $7692.16 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 225 310 483.10 $28986.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 33 55 55.23 $2584.92 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 40 46 65.00 $7774.00 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 38 54 52.64 $2632.22 $50.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.00 $75.00 $75.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 1.00 $48.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.00 $48.50 $48.50
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 539 1982 2330.98 $67565.53 $28.99
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 68 87 301.00 $451500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 38 61 254.05 $12702.40 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 320 435 616.25 $30812.50 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 2.00 $50.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3 3 4.38 $219.17 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 1 1 1.00 $25.00 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 221 365 570.07 $28503.37 $50.00
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.00 $50.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 42 75.11 $3755.28 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 293 472 819.65 $40982.69 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 7 7 8.69 $217.22 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 69 92 1202.46 $30061.40 $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 537 1186 13838.07 $691903.63 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 2.53 $126.67 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 48 88 573.19 $28659.72 $50.00
INTR -INTR INTERPRETER 3 3 9.00 $450.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 601 1201 7996.38 $542794.56 $67.88
OCCT -97530HM OT SESSION BY OT ASST 60 65 128.23 $6965.62 $54.32
PHY -97110 PT SESSION BY LICENSED PT 713 1443 9373.43 $636268.75 $67.88
PHY -97110HM PT SESSION BY PT ASST 68 70 127.93 $6948.89 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 144 147 147.00 $147.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 10 14 26.00 $13000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 12 14.00 $910.00 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 3 3 3.00 $342.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 12 14 25.00 $5928.00 $237.12
SENS -V5264 EARMOLD 29 50 99.67 $1865.76 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 42 71 402.17 $20108.34 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1125 2224 15797.32 $1072321.86 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 4 9.80 $532.34 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 93 98 207.50 $2739.00 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 35 94 612.30 $30614.86 $50.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1923 8360 53259.50 $3661818.76 $68.75
-----------------------------------------------------------------------------------------------------------------------------
Total 10342 55590.48 $3729384.29 $67.09
-----------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1995