Summary Report for FSPSAs Ending During the Report Period Center: 10
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: 01/01/09 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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 124 129 129.00 $1369.98 $10.62
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 121 126 126.00 $1112.58 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 121 128 128.00 $1382.40 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 121 126 126.00 $2745.54 $21.79
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 107 112 112.00 $3167.36 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 64 71 71.00 $4260.00 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 12 12.00 $561.60 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 14 18.00 $2152.80 $119.60
EVAL -EVAL DEVELOPMENTAL EVALUATION 8 10 9.71 $485.56 $50.00
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Subtotal (Total Children Is Unduplicated) 198 729 732.71 $17264.92 $23.56
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 16 16 54.00 $81000.00 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 10 11 21.60 $1080.24 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 117 135 152.04 $7602.09 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 1 1 1.00 $25.00 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 93 114 107.53 $5376.66 $50.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 2.23 $111.67 $50.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 108 131 116.79 $5839.40 $50.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 19 24 136.80 $3420.00 $25.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 2 2 18.40 $460.00 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 224 296 1645.08 $82253.84 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 3 3 11.10 $555.00 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 18 22 77.76 $3888.06 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 224 280 816.36 $55414.63 $67.88
OCCT -97530HM OT SESSION BY OT ASST 36 38 121.65 $6608.04 $54.32
PHY -97110 PT SESSION BY LICENSED PT 300 362 949.83 $64474.66 $67.88
PHY -97110HM PT SESSION BY PT ASST 29 30 82.28 $4469.62 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 75 75 75.00 $75.00 $1.00
SENS -FM FM RECEIVER HEARING AID 1 2 2.00 $3300.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 6.14 $3071.45 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 2.00 $130.00 $65.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 6 6 12.00 $2845.44 $237.12
SENS -V5264 EARMOLD 14 17 33.00 $617.76 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 16 18 46.05 $2302.50 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 420 534 1684.51 $114344.24 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 0.13 $7.25 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 69 71 272.07 $3591.28 $13.20
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 11 13 39.22 $1960.84 $50.00
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Subtotal (Total Children Is Unduplicated) 895 2211 6486.58 $454824.64 $70.12
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Total 2940 7219.29 $472089.56 $65.39
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Number of Children (Unduplicated) With at Least One Authorization 989