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: 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 2 2 1.25 $46.25 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 26 26 16.69 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 30 33 41.79 $1546.07 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 18.79 $695.07 $37.00
TCON -TCON TRANSITION CONFERENCE 5 5 5.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 48 70 83.52 $2287.40 $27.39
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 36 39 46.71 $2265.64 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.00 $108.21 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 124 129 129.00 $1369.98 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 1.33 $21.64 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 129 135 131.62 $1162.18 $8.83
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 131 139 136.04 $1469.28 $10.80
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.00 $8.44 $8.44
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 128 134 132.23 $2881.24 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 7 7 5.84 $317.82 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 109 114 114.00 $3223.92 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 1.52 $48.25 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 1 1 0.48 $10.20 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 257 267 269.38 $16162.76 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 26 28 29.00 $1357.20 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 157 159 277.26 $33160.15 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 12 12 14.50 $1811.91 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 15 17 43.71 $5464.29 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 53 57 67.41 $3370.60 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 135 141 222.46 $11123.22 $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 1 2 2.00 $150.00 $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 31 31 46.00 $3450.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 6.00 $450.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 13.00 $975.00 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 12 19.50 $1462.50 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 47 48 67.50 $3746.25 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 20 20 39.00 $2164.50 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 620 623 994.05 $74553.75 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 123 123 190.00 $14250.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 177 177 295.50 $22162.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 567 569 916.62 $50872.49 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 463 492 693.57 $52017.50 $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
NURS -NURS NURSING ASSESSMENT 4 4 14.00 $700.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 3 3 3.00 $150.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 110 125 124.30 $6028.48 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 570 622 664.74 $32240.02 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 116 129 140.29 $6803.86 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 391 422 424.16 $20571.63 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 25 25 25.00 $1250.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1354 1445 1531.01 $74253.77 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 1.03 $103.33 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 6 6 7.50 $375.00 $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) 3527 6293 7858.26 $454770.78 $57.87
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 100 114 256.83 $385242.90 $1500.00
AUD -HA_FUP AUDIOLOGY SERVICES 99 103 230.06 $11502.83 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 692 1022 1666.59 $83329.35 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 43 43 34.25 $856.37 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1189 1245 2000.11 $100005.43 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 59 60 86.48 $2162.00 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 561 609 855.23 $42761.40 $50.00
CONOP -CONOP CONSULT, OT, PHONE 19 19 21.84 $545.89 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 461 486 777.01 $38850.49 $50.00
CONPP -CONPP CONSULT, PT, PHONE 18 18 21.63 $540.73 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1278 1355 1984.39 $99219.68 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 97 99 119.63 $2990.69 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 18 20 156.92 $11521.35 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 8 8 780.71 $9758.93 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 5.47 $136.67 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 274 289 3397.73 $84943.28 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 139.93 $6996.42 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 3 3 2.74 $137.22 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 12 12 67.00 $3350.01 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 7 7 49.19 $1229.76 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3456 3806 21684.13 $1084206.58 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 13 15 43.95 $2197.30 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 50 57 169.86 $8493.06 $50.00
INTR -INTR INTERPRETER 87 100 465.39 $23269.53 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 1761 2028 10020.53 $680193.50 $67.88
OCCT -97530HM OT SESSION BY OT ASST 117 124 877.63 $47672.91 $54.32
PHY -97110 PT SESSION BY LICENSED PT 1861 2135 10306.73 $699620.55 $67.88
PHY -97110HM PT SESSION BY PT ASST 100 108 605.10 $32868.77 $54.32
RSPT -RSPT RESPITE 2 2 70.93 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 297 302 309.43 $309.43 $1.00
SENS -FM FM RECEIVER HEARING AID 4 5 5.00 $8250.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 18 18 24.92 $12460.35 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 7 7.00 $455.00 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 2.00 $228.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 8 9 17.00 $4031.04 $237.12
SENS -V5264 EARMOLD 62 65 105.20 $1969.28 $18.72
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 48 51 168.20 $8409.75 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4046 4665 23920.55 $1623726.75 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 7 15.01 $815.32 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 295 305 2112.57 $27885.98 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 7 7 29.92 $2991.90 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2774 3884 294470.00 $147234.99 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 1 1 7.60 $380.00 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 47 49 263.52 $13176.20 $50.00
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Subtotal (Total Children Is Unduplicated) 8328 23273 378355.91 $5316927.57 $14.05
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Total 29636 386297.68 $5773985.75 $14.95
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Number of Children (Unduplicated) With at Least One Authorization 8877