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: 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
Service Coordination, Class # 01
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.25 $9.25 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 64 64 69.57 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 30 33 37.29 $1379.57 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 4.00 $148.00 $37.00
TCON -TCON TRANSITION CONFERENCE 5 5 5.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 93 106 116.10 $1536.82 $13.24
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 26 28 30.00 $1455.00 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 13 13 13.00 $468.91 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 124 129 129.00 $1369.98 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.00 $16.30 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 123 128 128.00 $1130.24 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 124 131 131.00 $1414.80 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 123 128 128.00 $2789.12 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 2 2 2.00 $108.76 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 108 113 113.00 $3195.64 $28.28
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 1 1 1.00 $21.34 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 177 186 185.19 $11111.61 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 27 28 30.83 $1443.00 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 139 141 162.65 $19452.86 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 6.60 $824.41 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 32 33 50.71 $6339.30 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 87 95 103.93 $5196.27 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 117 124 188.96 $9448.22 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 7 7 7.00 $210.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 3 3.00 $225.00 $75.00
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 2 2 4.00 $222.00 $55.50
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 30 30 45.00 $3375.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 3.00 $225.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 11.00 $825.00 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 10 15.50 $1162.50 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 44 45 63.50 $3524.25 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 22 22 42.00 $2331.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 623 626 1017.55 $76316.25 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 125 125 194.00 $14550.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 190 190 321.50 $24112.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 579 581 942.05 $52283.78 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 459 487 686.57 $51492.50 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 1 1 1.00 $72.78 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 1.00 $150.00 $150.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 112 122 128.15 $6215.05 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 531 560 612.02 $29682.89 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 113 122 121.33 $5884.40 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 373 393 402.85 $19538.22 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 20 20 20.00 $1000.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1180 1262 1368.11 $66353.23 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 7.88 $787.62 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.00 $100.00 $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) 3400 5908 7426.87 $426500.32 $57.43
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 94 103 152.06 $228083.40 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 109 112 191.70 $9584.99 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 650 939 1563.20 $78159.83 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 36 36 27.10 $677.62 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1149 1255 2081.46 $104073.09 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 61 65 111.71 $2792.86 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 581 635 897.83 $44891.59 $50.00
CONOP -CONOP CONSULT, OT, PHONE 26 26 49.32 $1233.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 427 460 715.04 $35752.09 $50.00
CONPP -CONPP CONSULT, PT, PHONE 24 24 48.52 $1212.89 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1218 1337 2008.35 $100417.70 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 83 87 127.67 $3191.76 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 27 29 70.45 $5172.50 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 8 8 810.43 $10130.36 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 6.17 $154.17 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 242 266 1648.02 $41200.55 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 2.57 $128.57 $50.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 11 11 212.29 $10614.28 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 26 28 199.43 $9971.43 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 5 5 49.69 $1242.14 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3245 3632 21022.96 $1051147.79 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 4 4 15.53 $776.43 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 30 34 127.75 $6387.34 $50.00
INTR -INTR INTERPRETER 68 81 340.44 $17022.02 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 1740 1966 9654.19 $655326.20 $67.88
OCCT -97530HM OT SESSION BY OT ASST 139 145 749.44 $40709.49 $54.32
PHY -97110 PT SESSION BY LICENSED PT 1809 2031 9630.58 $653723.56 $67.88
PHY -97110HM PT SESSION BY PT ASST 119 131 623.26 $33855.60 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 259 264 345.80 $345.80 $1.00
SENS -FM FM RECEIVER HEARING AID 5 6 6.00 $9900.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 18 18 20.37 $10182.55 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 11 7.60 $493.99 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 4.00 $456.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 15 15 26.00 $6165.12 $237.12
SENS -V5264 EARMOLD 65 69 93.18 $1744.31 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 1.00 $50.00 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 44 48 172.36 $8618.20 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3817 4357 22157.72 $1504066.20 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 9 10 24.28 $1318.68 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 296 313 1832.01 $24182.51 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 5 5 26.78 $2677.61 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2557 3535 250384.60 $125192.30 $0.50
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 50 55 172.69 $8634.52 $50.00
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Subtotal (Total Children Is Unduplicated) 8039 22164 328411.53 $4851661.02 $14.77
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Total 28178 335954.50 $5279698.15 $15.72
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Number of Children (Unduplicated) With at Least One Authorization 9212