Summary Report for FSPSAs Ending During the Report Period Center: 10
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: 10/01/08 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 99 100 100.00 $1062.00 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 95 96 96.00 $847.68 $8.83
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 95 96 96.00 $1036.80 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 92 93 93.00 $2026.47 $21.79
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 86 87 87.00 $2460.36 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 68 79 80.07 $4804.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 13 13.00 $608.40 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 21.00 $2511.60 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 16 18 9.82 $491.12 $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) 187 598 597.89 $15959.50 $26.69
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 21 73.00 $109500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 17 17 44.32 $2215.95 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 116 135 162.75 $8137.50 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 1.00 $25.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1 1 0.28 $14.17 $50.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 87 98 94.30 $4714.96 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 7 5.48 $274.17 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 99 113 89.89 $4494.31 $50.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 18 20 126.53 $3163.34 $25.00
EIIF -COUN UNSPECIFIED COUNSELING 1 1 0.57 $28.34 $50.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 214 286 1829.62 $91481.11 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 19 22 97.95 $4897.64 $50.00
INTR -INTR INTERPRETER 2 2 7.00 $350.00 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 238 294 968.37 $65732.79 $67.88
OCCT -97530HM OT SESSION BY OT ASST 9 10 19.53 $1061.04 $54.32
PHY -97110 PT SESSION BY LICENSED PT 294 350 985.41 $66889.59 $67.88
PHY -97110HM PT SESSION BY PT ASST 6 6 11.49 $624.22 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 32 32 32.00 $32.00 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 8.00 $4000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 5.00 $325.00 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.00 $114.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 5 5 10.00 $2371.20 $237.12
SENS -V5264 EARMOLD 13 13 25.00 $468.00 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 14 16 43.38 $2169.17 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 442 554 1897.67 $128813.69 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.80 $43.46 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 15.30 $201.96 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 17 19 77.82 $3891.11 $50.00
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Subtotal (Total Children Is Unduplicated) 827 2042 6633.47 $506033.68 $76.28
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Total 2640 7231.36 $521993.18 $72.18
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Number of Children (Unduplicated) With at Least One Authorization 905