Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 01/01/09 and 03/31/09 Date of Report: 05-18-09 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
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 5.00 $234.00 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 5.00 $598.00 $119.60
EXIT -EXIT TRANSITION ASSESSMENT 2 2 2.00 $100.00 $50.00
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 3.00 $145.50 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.00 $48.50 $48.50
SPCH -92506 SPEECH EVAL BY LICENSED SLP 3 3 3.00 $145.50 $48.50
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Subtotal (Total Children Is Unduplicated) 14 19 19.00 $1271.50 $66.92
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 9 9.00 $13500.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 18 18 26.30 $1315.04 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 45 47 54.00 $2700.00 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 7 7 7.00 $175.00 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 22 22 39.73 $1986.43 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 3 3 0.97 $24.17 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 32 34 46.75 $2337.56 $50.00
CONOP -CONOP CONSULT, OT, PHONE 5 5 3.92 $97.92 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 27 31.76 $1588.22 $50.00
CONPP -CONPP CONSULT, PT, PHONE 4 4 5.67 $141.67 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 29 30.39 $1519.47 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 5 5 5.21 $130.21 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 60 67 966.00 $24150.00 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 183 200 1115.45 $55772.59 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 1.90 $95.00 $50.00
INTR -INTR INTERPRETER 17 22 66.36 $3317.86 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 105 114 501.60 $34048.28 $67.88
OCCT -97530HM OT SESSION BY OT ASST 16 17 101.19 $5496.41 $54.32
PHY -97110 PT SESSION BY LICENSED PT 143 160 711.24 $48279.14 $67.88
PHY -97110HM PT SESSION BY PT ASST 15 16 53.04 $2881.03 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 16 16 18.13 $18.13 $1.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 5 5 5.00 $2500.00 $500.00
SENS -V5264 EARMOLD 5 5 1.76 $32.86 $18.72
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 359 397 2022.00 $137253.60 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.86 $155.20 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 62 64 310.00 $4092.04 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 5 5 27.57 $1378.58 $50.00
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Subtotal (Total Children Is Unduplicated) 688 1300 6164.79 $344986.38 $55.96
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Total 1319 6183.79 $346257.88 $55.99
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Number of Children (Unduplicated) With at Least One Authorization 691