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: 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
CASE -CASE NON-TCM CASE MANAGEMENT 3 3 4.35 $161.04 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 1509 1583 2240.98 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 91 106 166.14 $6147.29 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 49 49 86.51 $3200.81 $37.00
TCON -TCON TRANSITION CONFERENCE 18 18 18.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 1613 1759 2515.98 $9509.14 $3.78
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 133 174 211.58 $10261.65 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 12 13 15.39 $555.08 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 311 345 501.00 $5320.62 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 3 3.00 $48.90 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 276 300 300.00 $2649.00 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 4.00 $108.40 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 279 304 304.31 $3286.56 $10.80
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.00 $8.44 $8.44
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 271 297 296.31 $6456.62 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 9 10 10.00 $543.80 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 248 270 271.00 $7663.88 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.00 $31.81 $31.81
AUDE -AUDE UNSPECIFIED AUDE SERVICES 655 775 1217.07 $73024.07 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 80 103 113.06 $5291.26 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 485 515 664.11 $79427.34 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 2 2 2.00 $250.00 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 17 17 42.14 $5267.85 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 105 110 413.47 $51684.05 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 935 1171 1442.18 $72108.98 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 244 274 358.07 $17903.58 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 72 72 86.00 $2580.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 19 19 24.50 $1837.50 $75.00
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 3 3 4.00 $222.00 $55.50
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 97 100 134.48 $10086.20 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 14 14 17.51 $1312.92 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 21 21 31.23 $2342.09 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 90 92 118.57 $8892.86 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 204 217 281.72 $15635.59 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 84 84 96.50 $5355.75 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1805 1822 2557.64 $191823.23 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 429 435 596.43 $44732.15 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 511 515 741.60 $55620.36 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1645 1675 2406.00 $133532.75 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1877 2092 2926.70 $219502.87 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 9 10 12.00 $873.36 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 6 6 6.00 $900.00 $150.00
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 2.27 $113.34 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 9 10 10.00 $500.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 418 581 701.51 $34023.17 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1830 2109 2411.16 $116941.11 $48.50
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 8 8 14.77 $2215.49 $150.00
PDFO -T1024HTTS *PSY-DEV EVAL OUTPATIENT, FOLLOW-UP 2 2 0.68 $102.11 $150.00
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 442 635 722.91 $35061.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1316 1504 1770.72 $85880.08 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 95 95 101.00 $5050.00 $50.00
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.00 $15.00 $15.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 3706 4662 5478.42 $265703.28 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 4 4 4.00 $400.00 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 22 27 66.20 $3309.77 $50.00
WHEELO-97003TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 5.00 $242.50 $48.50
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 1.00 $48.50 $48.50
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Subtotal (Total Children Is Unduplicated) 10603 21509 27502.21 $1586746.83 $57.70
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 433 559 898.39 $1347590.40 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 5 10.38 $714.62 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 6 9.01 $620.50 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 343 409 1358.24 $67911.86 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1813 3552 6543.46 $327173.02 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 116 133 258.43 $6460.63 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3009 4444 15363.32 $768166.02 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 284 312 1368.11 $34202.71 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 1598 2351 6493.71 $324685.48 $50.00
CONOP -CONOP CONSULT, OT, PHONE 98 107 343.54 $8588.40 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 1098 1632 4639.48 $231973.75 $50.00
CONPP -CONPP CONSULT, PT, PHONE 66 79 290.27 $7256.66 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3217 4539 14275.71 $713785.28 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 406 458 1727.08 $43177.10 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 94 101 851.82 $62540.75 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 42 52 10058.14 $125726.79 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 17 18 72.53 $1813.33 $25.00
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 130 131 2051.47 $51286.81 $25.00
EIGF -T1027TTHM EI GROUP SESSION BY PARAPROF 2 2 15.00 $187.50 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 739 1057 15110.45 $377761.26 $25.00
EIIF -90812 INDIVIDUAL PSYCHOTHERAPY, 45-50 MIN 1 1 3.77 $188.34 $50.00
EIIF -90846 FAMILY PSYCHOTHERAPY W/O PATIENT 1 1 7.71 $385.72 $50.00
EIIF -90847 FAMILY PSYCHOTHERAPY WITH PATIENT 1 1 8.29 $414.29 $50.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 28 30 788.80 $39440.01 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 13 14 104.43 $5221.35 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 82 106 1662.14 $83107.15 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1781 1830 15925.04 $796251.79 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 24 25 389.70 $9742.62 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7856 12048 194565.43 $9728271.38 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 2 39.29 $1964.29 $50.00
HERN -T1024HN *EI HEARING SERVICES AFTER SHINE 22 22 246.56 $12328.09 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 82 128 1298.88 $64943.88 $50.00
INTR -INTR INTERPRETER 179 264 2518.63 $125931.63 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 4866 8346 97252.98 $6601532.40 $67.88
OCCT -97530HM OT SESSION BY OT ASST 485 558 8245.04 $447870.72 $54.32
PHY -97110 PT SESSION BY LICENSED PT 4838 8305 98860.30 $6710636.87 $67.88
PHY -97110HM PT SESSION BY PT ASST 495 577 8941.75 $485715.74 $54.32
RSPT -RSPT RESPITE 1 1 103.47 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 165 174 1087.18 $1087.18 $1.00
SENS -FM FM RECEIVER HEARING AID 12 12 15.43 $25457.19 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 59 67 97.50 $48750.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 24 28 33.78 $2195.99 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 5 5 6.00 $684.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 25 27 101.54 $24077.83 $237.12
SENS -V5264 EARMOLD 138 178 398.76 $7464.80 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 2 26.43 $1321.43 $50.00
SHIN -T1024HN *INITIAL SHINE SERVICES, INDIVIDUAL 8 8 56.59 $2829.29 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 116 173 1375.63 $68781.72 $50.00
SIC -SIC SPECIAL INSTRUCTION CONSULTATION 3 3 30.29 $1514.29 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9970 16694 202665.87 $13756959.54 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 85 90 790.14 $42920.16 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 910 1099 18447.82 $243511.28 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 42 68 318.41 $31840.51 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 6018 11765 1696833.41 $848416.67 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 3 3 153.71 $7685.71 $50.00
VISN -T1024HN *EI VISION SERVICES, INDIVIDUAL 41 41 386.04 $19302.04 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 138 235 2627.83 $131391.27 $50.00
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Subtotal (Total Children Is Unduplicated) 18654 82878 2438153.09 $44881759.96 $18.41
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Total 106146 2468171.28 $46478015.93 $18.83
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Number of Children (Unduplicated) With at Least One Authorization 20835