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: 01/01/10 and 03/31/10 Date of Report: 05-17-10 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 0.25 $9.25 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 3 3 9.59 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 12.57 $465.14 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 12.86 $475.71 $37.00
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Subtotal (Total Children Is Unduplicated) 10 10 35.27 $950.10 $26.94
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 54 58 64.00 $3104.00 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.00 $36.07 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 103 103 96.23 $1022.00 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 8 8 6.17 $100.52 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 105 105 93.21 $823.00 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.03 $28.00 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 107 107 94.91 $1024.98 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 106 106 93.27 $2032.40 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 6 7 5.32 $289.42 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 85 85 78.42 $2217.77 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 5.20 $165.42 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 2 2 1.87 $39.84 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 208 216 215.72 $12943.19 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 39 39 40.00 $1872.00 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 137 138 153.76 $18389.17 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 6 6 6.00 $750.00 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 16 16 25.29 $3160.71 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 23 24 31.39 $1569.64 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 253 268 513.50 $25675.00 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 64 67 119.50 $8962.50 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 12 12 23.00 $1725.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 26.30 $1972.50 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 56 57 106.80 $8010.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 50 54 92.00 $5106.00 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 17 17 34.00 $1887.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 716 786 1477.78 $110833.22 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 216 222 417.36 $31301.78 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 197 206 390.00 $29250.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 665 731 1374.24 $76270.48 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 424 489 887.29 $66546.43 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 3 3 4.00 $291.12 $72.78
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 3 3 5.82 $290.95 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 116 133 134.43 $6519.79 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 662 709 759.34 $36828.05 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 129 141 146.21 $7091.31 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 476 493 522.73 $25352.25 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 25 26 27.00 $1350.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1386 1511 1586.65 $76952.71 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 5.86 $585.71 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 4 4 4.00 $200.00 $50.00
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 3.00 $145.50 $48.50
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Subtotal (Total Children Is Unduplicated) 3950 6979 9673.58 $572715.43 $59.20
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 95 98 203.00 $304500.00 $1500.00
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 9.57 $659.09 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 133 136 288.27 $14413.66 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 667 860 1258.41 $62920.60 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 31 31 25.82 $645.54 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1119 1204 1930.92 $96545.80 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 61 61 78.67 $1966.68 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 528 589 771.28 $38563.85 $50.00
CONOP -CONOP CONSULT, OT, PHONE 20 20 26.86 $671.46 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 395 428 642.40 $32120.04 $50.00
CONPP -CONPP CONSULT, PT, PHONE 21 21 31.25 $781.16 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1274 1365 1990.62 $99531.07 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 87 87 127.73 $3193.28 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 10 95.00 $6974.90 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 4 4 87.57 $1094.64 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 22.80 $570.00 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 254 286 2085.02 $52125.38 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 3 209.00 $10450.00 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 7 7 6.65 $332.31 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 16 18 125.21 $6260.73 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 11 11 74.57 $1864.29 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3798 4148 24875.92 $1243796.16 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 14 14 30.77 $1538.53 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 44 47 305.62 $15281.05 $50.00
INTR -INTR INTERPRETER 174 206 755.48 $37773.82 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 1803 2050 10433.33 $708214.56 $67.88
OCCT -97530HM OT SESSION BY OT ASST 86 87 611.42 $33212.42 $54.32
PHY -97110 PT SESSION BY LICENSED PT 2020 2285 10654.95 $723257.73 $67.88
PHY -97110HM PT SESSION BY PT ASST 95 97 719.26 $39070.17 $54.32
RSPT -RSPT RESPITE 1 1 1.00 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 463 471 474.48 $474.48 $1.00
SENS -FM FM RECEIVER HEARING AID 4 4 6.00 $9900.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 25 25 30.00 $15000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 10 9.43 $613.14 $65.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 16 16 30.80 $7303.30 $237.12
SENS -V5264 EARMOLD 82 84 110.42 $2067.14 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 3 3 9.43 $471.67 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 72 90 238.93 $11946.26 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4304 4928 24338.57 $1652101.82 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 11 11 63.89 $3470.28 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 180 190 1313.24 $17334.83 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 3 3 10.14 $1014.29 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2809 3852 479741.03 $239870.52 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 3 9.40 $469.77 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 47 50 290.91 $14545.38 $50.00
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Subtotal (Total Children Is Unduplicated) 8812 23924 565155.02 $5514911.69 $9.76
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Total 30913 574863.87 $6088577.23 $10.59
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Number of Children (Unduplicated) With at Least One Authorization 10241