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: 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
Service Coordination, Class # 01
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 282 282 291.67 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 22 24 19.43 $718.86 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 6.84 $253.02 $37.00
TCON -TCON TRANSITION CONFERENCE 3 3 3.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 309 317 320.94 $971.88 $3.03
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 42 46 49.86 $2418.07 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 6.34 $228.84 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 100 101 101.00 $1072.62 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 2.00 $32.60 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 97 98 98.00 $865.34 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.00 $54.20 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 97 98 98.00 $1058.40 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 94 95 95.00 $2070.05 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 1 1 1.00 $54.38 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 86 87 87.00 $2460.36 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 208 222 222.79 $13367.34 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 38 38 36.02 $1685.58 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 137 138 172.61 $20644.62 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 2 2 2.00 $250.00 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 4 4 4.00 $500.00 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 27 27 40.62 $5076.98 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 115 124 128.33 $6416.59 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 85 96 148.54 $7426.79 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 6 6 6.00 $180.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 3.50 $262.50 $75.00
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 1.00 $55.50 $55.50
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 34 34 49.07 $3680.36 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 9.50 $712.50 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 10.50 $787.50 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 10 10 14.07 $1055.36 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 43 44 62.00 $3441.00 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 22 22 28.00 $1554.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 497 500 743.43 $55757.15 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 102 102 147.50 $11062.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 150 151 242.64 $18198.22 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 440 440 674.32 $37424.72 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 430 488 738.36 $55376.79 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 4 4 6.00 $436.68 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 1.00 $150.00 $150.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 3 4 4.00 $200.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 116 122 120.41 $5839.90 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 536 572 599.79 $29089.88 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 117 131 141.25 $6850.55 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 388 401 440.09 $21344.24 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 26 26 26.00 $1300.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1131 1202 1268.54 $61524.22 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 2.00 $200.00 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 8 8 14.57 $728.57 $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) 3296 5475 6649.64 $382943.37 $57.59
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 126 144 214.71 $322071.45 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.47 $32.14 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.86 $58.92 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 126 128 220.93 $11046.55 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 632 948 1638.01 $81900.60 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 47 51 53.72 $1342.98 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1109 1176 1950.62 $97531.09 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 65 70 99.87 $2496.66 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 580 617 885.97 $44298.25 $50.00
CONOP -CONOP CONSULT, OT, PHONE 25 26 31.84 $796.04 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 363 382 583.82 $29190.96 $50.00
CONPP -CONPP CONSULT, PT, PHONE 33 34 59.76 $1493.90 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1174 1268 1835.64 $91781.82 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 96 104 137.42 $3435.39 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 31 31 104.86 $7698.89 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 9 9 325.00 $4062.50 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 3 3 2.57 $64.17 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 284 302 2697.05 $67426.32 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 70.14 $3507.14 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 3 3 7.06 $353.10 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 13 13 101.86 $5092.86 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 4 4 11.14 $557.15 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 8 8 56.14 $1403.57 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3257 3590 20909.81 $1045490.56 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 0.14 $7.15 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 33 36 135.86 $6792.89 $50.00
INTR -INTR INTERPRETER 65 69 300.85 $15042.73 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 1919 2153 10554.55 $716442.69 $67.88
OCCT -97530HM OT SESSION BY OT ASST 123 129 682.14 $37053.99 $54.32
PHY -97110 PT SESSION BY LICENSED PT 1937 2145 9969.16 $676706.84 $67.88
PHY -97110HM PT SESSION BY PT ASST 138 140 754.82 $41001.89 $54.32
RSPT -RSPT RESPITE 1 1 49.07 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 136 140 328.81 $328.81 $1.00
SENS -FM FM RECEIVER HEARING AID 4 4 4.00 $6600.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 27 27 34.50 $17250.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 13 13 8.33 $541.73 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 3.00 $342.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 8 8 55.14 $13075.48 $237.12
SENS -V5264 EARMOLD 60 60 83.72 $1567.28 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 2 7.57 $378.57 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 44 47 214.34 $10717.02 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3994 4537 23367.56 $1586190.16 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 11 11 43.91 $2385.04 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 246 250 1820.24 $24027.18 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 8 8 25.30 $2530.47 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2439 3389 237713.26 $118856.62 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 31.57 $1578.58 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 59 64 285.66 $14283.13 $50.00
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Subtotal (Total Children Is Unduplicated) 8123 22159 318472.78 $5116833.22 $16.07
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Total 27951 325443.37 $5500748.47 $16.90
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Number of Children (Unduplicated) With at Least One Authorization 9255