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: 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 24 24 14.95 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 21 23 18.00 $666.00 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 2.77 $102.37 $37.00
TCON -TCON TRANSITION CONFERENCE 3 3 3.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 35 51 38.71 $768.37 $19.85
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 39 41 43.00 $2085.50 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 23 23 25.00 $901.75 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 102 103 103.00 $1093.86 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 4.00 $65.20 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 100 101 101.00 $891.83 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.00 $54.20 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 102 103 103.00 $1112.40 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 95 96 96.00 $2091.84 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 1 1 1.00 $54.38 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 89 90 90.00 $2545.20 $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 169 187 194.20 $11652.25 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 38 41 42.35 $1981.98 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 159 162 185.56 $22192.45 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 11.29 $1410.71 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 7 7 10.70 $1337.50 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 34 34 41.29 $5160.73 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 61 62 81.03 $4051.35 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 89 95 152.54 $7626.79 $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 4 4.50 $337.50 $75.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 32 32 47.07 $3530.36 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 6.50 $487.50 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 9.50 $712.50 $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 38 39 53.00 $2941.50 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 17 17 31.00 $1720.50 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 481 484 735.43 $55157.15 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 98 98 145.50 $10912.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 151 152 254.64 $19098.22 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 452 452 697.32 $38701.22 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 405 464 711.36 $53351.79 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 4 4 6.00 $436.68 $72.78
NURS -NURS NURSING ASSESSMENT 4 4 2.80 $140.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 2 2 2.00 $100.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 102 104 102.24 $4958.59 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 514 552 567.84 $27540.30 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 91 98 105.76 $5129.45 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 336 361 394.14 $19115.66 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 21 21 20.73 $1036.67 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1092 1147 1209.06 $58639.46 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 7.00 $700.00 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.00 $100.00 $50.00
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Subtotal (Total Children Is Unduplicated) 3014 5220 6425.41 $372467.30 $57.97
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 105 113 147.71 $221571.45 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.56 $38.26 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 130 138 235.27 $11763.68 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 616 929 1523.61 $76180.72 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 39 40 34.00 $849.94 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1126 1186 2090.49 $104524.59 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 57 58 110.21 $2755.28 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 536 586 879.43 $43971.30 $50.00
CONOP -CONOP CONSULT, OT, PHONE 28 29 64.90 $1622.48 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 365 385 664.63 $33231.68 $50.00
CONPP -CONPP CONSULT, PT, PHONE 27 28 44.87 $1121.67 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1261 1336 2044.38 $102219.20 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 83 91 124.91 $3122.78 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 13 13 67.01 $4919.84 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 4 4 412.57 $5157.14 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 3 3.83 $95.83 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 223 240 1660.09 $41502.27 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 7 44.14 $2207.15 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 2 2 11.80 $590.24 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 12 13 102.43 $5121.44 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 6 7 38.71 $967.86 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3152 3481 22009.87 $1100493.55 $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 38 42 122.82 $6141.16 $50.00
INTR -INTR INTERPRETER 67 72 340.57 $17028.70 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 1711 1935 10764.70 $730707.66 $67.88
OCCT -97530HM OT SESSION BY OT ASST 157 166 674.45 $36636.00 $54.32
PHY -97110 PT SESSION BY LICENSED PT 1660 1868 10017.09 $679959.86 $67.88
PHY -97110HM PT SESSION BY PT ASST 132 135 540.82 $29377.32 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 280 283 287.29 $287.29 $1.00
SENS -FM FM RECEIVER HEARING AID 7 7 8.00 $13200.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 28 29 40.72 $20361.10 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 11 11 9.43 $612.96 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 3 3 5.00 $570.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 11 13 26.00 $6165.12 $237.12
SENS -V5264 EARMOLD 61 67 99.63 $1865.11 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 48 50 242.37 $12118.70 $50.00
SIC -SIC SPECIAL INSTRUCTION CONSULTATION 1 1 11.86 $592.86 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3788 4346 24229.55 $1644701.58 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 9 44.19 $2400.55 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 290 296 1733.52 $22882.48 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 11 13 59.37 $5936.66 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2576 3467 275833.02 $137916.50 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 54 58 284.14 $14206.92 $50.00
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Subtotal (Total Children Is Unduplicated) 7768 21562 357692.52 $5147823.49 $14.39
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Total 26833 364156.64 $5521059.16 $15.16
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Number of Children (Unduplicated) With at Least One Authorization 8235