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: 04/01/10 and 06/30/10 Date of Report: 08-17-10 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
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 5 5 4.14 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 9.00 $333.00 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.29 $10.57 $37.00
TCON -TCON TRANSITION CONFERENCE 3 3 3.00 $0.00 $0.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 11 12 16.43 $343.57 $20.91
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 67 70 73.00 $3540.50 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 5.00 $180.35 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 114 117 115.10 $1222.36 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.59 $25.90 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 112 114 110.09 $972.13 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 116 118 119.84 $1294.24 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 114 116 112.61 $2453.68 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 9 10 13.80 $750.62 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 85 86 85.07 $2405.69 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 9.30 $295.93 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 1 1 1.00 $21.34 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 230 235 233.92 $14035.33 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 25 25 23.08 $1080.04 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 137 137 147.66 $17659.62 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 3 3 16.86 $2107.15 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 16 17 25.58 $3197.63 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 28 28 34.81 $1740.52 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 358 381 695.71 $34785.72 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 65 66 128.00 $9600.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 11.00 $825.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 9.00 $675.00 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 45 45 86.50 $6487.50 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 49 49 89.64 $4975.18 $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 717 731 1433.79 $107533.93 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 207 209 399.00 $29925.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 193 196 383.50 $28762.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 598 605 1182.85 $65648.31 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 380 407 786.50 $58987.50 $75.00
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 2.00 $300.00 $150.00
NURS -NURS NURSING ASSESSMENT 1 1 1.40 $70.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 6 6 6.00 $300.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 126 136 136.00 $6596.00 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 657 700 740.49 $35913.71 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 125 133 132.14 $6408.93 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 473 495 498.85 $24194.07 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 37 37 37.00 $1850.00 $50.00
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 2.00 $30.00 $15.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1449 1581 1701.26 $82511.30 $48.50
VISF -VISF VISION EVALUATION FUNCTIONAL 3 3 3.00 $150.00 $50.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 4171 6903 9628.94 $561426.77 $58.31
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 94 102 168.93 $253399.95 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 1.07 $73.45 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 7.18 $494.15 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 131 137 271.20 $13560.07 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 875 1247 1993.81 $99690.38 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 47 49 37.06 $926.49 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1242 1378 2019.13 $100956.35 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 76 80 187.88 $4696.95 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 579 633 889.31 $44465.51 $50.00
CONOP -CONOP CONSULT, OT, PHONE 20 21 21.00 $524.89 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 468 508 793.90 $39694.77 $50.00
CONPP -CONPP CONSULT, PT, PHONE 24 24 36.81 $920.37 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1390 1542 2004.80 $100239.86 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 93 98 205.39 $5134.81 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 9 9 25.27 $1855.07 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 3 3 186.71 $2333.93 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 7 8 62.06 $1551.43 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 275 322 2371.54 $59288.54 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 223.43 $11171.43 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 7 7 3.30 $165.00 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 31 35 243.80 $12189.77 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 6 6 32.87 $821.79 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4070 4605 26327.33 $1316366.44 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 22 24 24.92 $1245.83 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 53 63 275.26 $13762.98 $50.00
INTR -INTR INTERPRETER 188 239 769.98 $38498.78 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 1852 2117 10429.37 $707945.74 $67.88
OCCT -97530HM OT SESSION BY OT ASST 95 103 595.81 $32364.63 $54.32
PHY -97110 PT SESSION BY LICENSED PT 1983 2199 10208.66 $692963.89 $67.88
PHY -97110HM PT SESSION BY PT ASST 94 97 668.59 $36317.98 $54.32
RSPT -RSPT RESPITE 2 2 39.40 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 456 472 475.63 $475.63 $1.00
SENS -FM FM RECEIVER HEARING AID 3 3 3.00 $4950.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 22 22 30.00 $15000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 12 14 13.41 $871.36 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 2.00 $228.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 5 5 6.00 $1422.72 $237.12
SENS -V5264 EARMOLD 77 79 123.40 $2310.02 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 2 2 12.08 $603.81 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 62 71 163.18 $8159.11 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4389 5056 25191.02 $1709966.49 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 30.11 $1635.42 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 214 227 1714.28 $22628.54 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 4 5 8.57 $857.14 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 3097 4360 508317.16 $254158.59 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 3 3 5.22 $260.84 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 64 72 293.05 $14652.68 $50.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 9240 26066 597513.86 $5631801.53 $9.43
-----------------------------------------------------------------------------------------------------------------------------
Total 32981 607159.23 $6193571.87 $10.20
-----------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 10705