Summary Report for FSPSAs Initiated During the Report Period Statewide
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
Service Coordination, Class # 01
CASE -CASE NON-TCM CASE MANAGEMENT 3 3 4.35 $161.04 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 530 572 611.34 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 92 107 179.71 $6649.43 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 40 40 81.90 $3030.36 $37.00
TCON -TCON TRANSITION CONFERENCE 18 18 18.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 614 740 895.31 $9840.83 $10.99
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 129 164 203.58 $9873.65 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 36 36 55.86 $2014.77 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 312 347 503.00 $5341.86 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 6 6.00 $97.80 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 280 305 305.00 $2693.15 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 5.00 $135.50 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 282 308 309.00 $3337.20 $10.80
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.00 $8.44 $8.44
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 272 299 299.00 $6515.21 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 9 10 10.00 $543.80 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 250 273 274.00 $7748.72 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.00 $31.81 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 2 2 2.00 $42.68 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 678 815 1263.88 $75832.81 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 96 127 138.91 $6501.04 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 523 556 732.81 $87643.49 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 3 3 13.29 $1660.71 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 17 17 20.70 $2587.50 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 121 126 415.05 $51881.29 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 819 986 1328.04 $66402.07 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 273 305 409.07 $20453.58 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 65 65 65.00 $1950.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 19 20 25.50 $1912.50 $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 98 101 135.48 $10161.20 $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 20 20 30.23 $2267.09 $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 208 221 284.91 $15812.57 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 93 93 114.50 $6354.75 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1828 1846 2641.21 $198091.09 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 434 440 606.71 $45503.57 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 524 528 772.60 $57945.36 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1666 1697 2495.00 $138472.25 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1879 2095 2933.20 $219990.37 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 9 10 12.00 $873.36 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 5 5 5.00 $750.00 $150.00
NURS -NURS NURSING ASSESSMENT 4 4 2.80 $140.00 $50.00
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 1.50 $75.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 6 7 7.00 $350.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 400 548 671.38 $32562.17 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1908 2257 2666.90 $129344.45 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 395 569 630.48 $30578.05 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1358 1592 1779.40 $86301.11 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 98 98 97.73 $4886.67 $50.00
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.00 $15.00 $15.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 4023 5081 5861.11 $284263.71 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 6 6 15.47 $1546.67 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 18 21 47.71 $2385.72 $50.00
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 1.00 $48.50 $48.50
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Subtotal (Total Children Is Unduplicated) 10788 22129 28341.10 $1634355.99 $57.67
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 432 574 876.30 $1314457.20 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 5 9.21 $634.28 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 3.98 $273.90 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 396 474 1494.22 $74710.79 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1842 4019 7539.55 $376977.47 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 105 123 222.32 $5557.92 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3515 4938 16511.58 $825578.78 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 277 311 1241.07 $31026.86 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 1718 2457 6777.10 $338854.95 $50.00
CONOP -CONOP CONSULT, OT, PHONE 100 114 322.11 $8052.77 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 1187 1678 4817.73 $240886.74 $50.00
CONPP -CONPP CONSULT, PT, PHONE 80 101 340.15 $8503.69 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3767 5124 15360.38 $768019.11 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 351 401 1275.34 $31883.43 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 85 92 613.52 $45044.32 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 31 34 10093.71 $126171.43 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 19 22 80.57 $2014.16 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 876 1231 16400.50 $410012.52 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 23.86 $1192.86 $50.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 26 34 1002.57 $50128.58 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 6 6 16.76 $838.02 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 82 101 1765.43 $88271.45 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1 1 5.86 $292.86 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 21 25 361.70 $9042.62 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9328 14480 210629.29 $10531464.52 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 2 2 33.25 $1662.38 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 97 151 1359.55 $67977.58 $50.00
INTR -INTR INTERPRETER 205 296 2525.59 $126279.75 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 4909 8305 95273.96 $6467196.44 $67.88
OCCT -97530HM OT SESSION BY OT ASST 463 556 7142.47 $387978.95 $54.32
PHY -97110 PT SESSION BY LICENSED PT 4823 8288 96820.39 $6572167.88 $67.88
PHY -97110HM PT SESSION BY PT ASST 456 522 7182.86 $390172.69 $54.32
RSPT -RSPT RESPITE 1 1 103.47 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 483 519 1706.84 $1706.84 $1.00
SENS -FM FM RECEIVER HEARING AID 15 15 16.00 $26400.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 75 84 121.72 $60861.10 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 34 38 36.40 $2366.23 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 6 6 8.00 $912.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 30 34 117.14 $27776.92 $237.12
SENS -V5264 EARMOLD 165 217 446.49 $8358.38 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 2 26.43 $1321.43 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 142 206 1591.21 $79560.53 $50.00
SIC -SIC SPECIAL INSTRUCTION CONSULTATION 3 3 39.29 $1964.29 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10573 17473 207111.08 $14058700.04 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 30 36 483.91 $26285.83 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 960 1102 16573.55 $218770.86 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 43 66 315.31 $31530.50 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 6817 13592 2296154.66 $1148077.29 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 145.14 $7257.14 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 160 275 2849.69 $142484.25 $50.00
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Subtotal (Total Children Is Unduplicated) 19582 88140 3035969.20 $45147660.48 $14.87
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Total 111009 3065205.60 $46791857.30 $15.27
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Number of Children (Unduplicated) With at Least One Authorization 20871