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: 10/01/09 and 12/31/09 Date of Report: 02-15-10 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 2.00 $74.00 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 3 3 0.71 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 32.57 $1205.14 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 25.50 $943.50 $37.00
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Subtotal (Total Children Is Unduplicated) 10 10 60.78 $2222.65 $36.57
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 41 43 46.71 $2265.64 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.00 $36.07 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 103 104 104.00 $1104.48 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 3.62 $59.04 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 108 109 106.93 $944.22 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.00 $54.20 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 108 109 106.93 $1154.88 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 108 109 105.96 $2308.77 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 5 5 3.80 $206.64 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 93 94 94.00 $2658.32 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 2.62 $83.42 $31.81
AUDE -AUDE UNSPECIFIED AUDE SERVICES 247 256 260.96 $15657.53 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 36 36 65.62 $3070.97 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 149 149 160.30 $19171.88 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 9 10 15.00 $1875.00 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 18 18 24.29 $3035.71 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 37 37 50.74 $2536.75 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 254 274 526.21 $26310.72 $50.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 4.00 $300.00 $75.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 40 40 65.00 $4875.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 13.00 $975.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 13 21.50 $1612.50 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 37 38 59.50 $4462.50 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 59 59 90.51 $5023.54 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 27 27 54.00 $2997.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 578 579 1034.50 $77587.50 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 231 232 422.79 $31708.93 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 118 118 211.89 $15891.79 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 484 487 868.35 $48193.29 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 393 413 698.21 $52366.07 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 5 5 7.00 $509.46 $72.78
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 1 1 1.00 $50.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 113 130 140.94 $6835.58 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 733 793 836.63 $40576.55 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 123 143 154.00 $7469.00 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 501 519 539.73 $26176.88 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 31 32 32.00 $1600.00 $50.00
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 4 4.00 $60.00 $15.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1513 1657 1737.45 $84266.39 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 9.41 $940.96 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 3.00 $150.00 $50.00
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Subtotal (Total Children Is Unduplicated) 3999 6669 8689.11 $497162.19 $57.22
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 111 125 225.00 $337500.00 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 4 20.94 $1441.80 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 13.00 $895.18 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 121 124 252.81 $12640.27 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 686 911 1375.49 $68774.34 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 49 52 32.76 $819.11 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1226 1313 2045.46 $102273.14 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 53 57 69.47 $1736.87 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 572 616 810.80 $40540.13 $50.00
CONOP -CONOP CONSULT, OT, PHONE 17 18 18.18 $454.58 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 425 450 656.66 $32833.21 $50.00
CONPP -CONPP CONSULT, PT, PHONE 17 17 15.05 $376.20 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1367 1466 2015.86 $100792.90 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 75 81 96.09 $2402.18 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 9 9 138.86 $10194.89 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 12 12 565.00 $7062.50 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 244 263 1979.40 $49485.00 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 165.86 $8292.86 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 2 2 7.98 $399.21 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 14 14 78.87 $3943.57 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 4 4 28.29 $707.15 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3664 4059 23337.41 $1166870.53 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 18 19 30.81 $1540.70 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 48 52 230.34 $11517.21 $50.00
INTR -INTR INTERPRETER 149 160 628.64 $31432.08 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 1925 2214 10823.56 $734703.45 $67.88
OCCT -97530HM OT SESSION BY OT ASST 86 90 584.57 $31753.79 $54.32
PHY -97110 PT SESSION BY LICENSED PT 2020 2265 10193.57 $691939.31 $67.88
PHY -97110HM PT SESSION BY PT ASST 92 99 604.04 $32811.63 $54.32
RSPT -RSPT RESPITE 1 1 16.00 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 429 447 458.36 $458.36 $1.00
SENS -FM FM RECEIVER HEARING AID 7 7 7.00 $11550.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 27 27 33.00 $16500.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 18 18 14.40 $935.82 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 4 4 4.00 $456.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 14 14 23.00 $5453.76 $237.12
SENS -V5264 EARMOLD 75 78 109.55 $2050.71 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 6 6 13.84 $692.19 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 75 81 221.92 $11096.18 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4537 5206 25463.42 $1728457.04 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 20.29 $1101.92 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 202 213 1317.72 $17393.85 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 4 4 20.14 $2014.29 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2954 4067 464872.02 $232436.00 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 9.23 $461.43 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 63 69 368.39 $18419.44 $50.00
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Subtotal (Total Children Is Unduplicated) 9048 24753 550017.06 $5535610.75 $10.06
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Total 31432 558766.95 $6034995.59 $10.80
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Number of Children (Unduplicated) With at Least One Authorization 10365