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: 07/01/10 and 09/30/10 Date of Report: 11-17-10 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 11 11 14.000000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 3.428571 $126.8600 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 4 5.700000 $210.9000 $37.0000
TCON -TCON TRANSITION CONFERENCE 4 4 4.000000 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 18 21 27.128571 $337.7600 $12.4500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 68 77 80.000000 $3880.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 10.500000 $426.7200 $40.6400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 72 72 72.000000 $887.7600 $12.3300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 6 6 5.377778 $85.2900 $15.8600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 81 81 79.066667 $680.7600 $8.6100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 85 85 83.444445 $901.2000 $10.8000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 80 80 78.444445 $1719.5000 $21.9200
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 7 7 7.000000 $376.8100 $53.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 69 69 69.000000 $1951.3200 $28.2800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 8 7.377778 $232.5500 $31.5200
AUDE -AUDE UNSPECIFIED AUDE SERVICES 247 255 281.903175 $16914.1900 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 58 60 68.422222 $3079.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 166 170 194.179365 $22330.6200 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 3 3 7.142857 $892.8600 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 25 27 38.000000 $4750.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 12 12 23.585714 $1179.2900 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 346 363 675.321428 $33766.0700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 49 50 100.000000 $7500.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 17.500000 $1312.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 27.500000 $2062.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 42 43 86.000000 $6450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 51 51 90.500000 $5022.7500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 559 560 1100.066667 $82505.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 211 212 394.066666 $29555.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 186 186 366.500000 $27487.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 470 470 921.066667 $51119.2000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 499 529 1025.550000 $76916.2500 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 4 4 6.000000 $436.6800 $72.7800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 4 4 5.400000 $270.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 118 126 126.000000 $6111.0000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 701 754 801.707938 $38882.8300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 122 126 148.691270 $7211.5300 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 443 462 509.050795 $24688.9600 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 52 54 54.000000 $2700.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1390 1501 1676.540479 $81312.2100 $48.5000
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 3.000000 $145.5000 $48.5000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3942 6541 9242.906356 $545883.3700 $59.0600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 100 114 205.428571 $308142.9000 $1500.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 3.307241 $236.8400 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 5.000000 $358.0500 $71.6100
AUD -HA_FUP AUDIOLOGY SERVICES 150 157 291.517459 $14575.8800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 839 1226 1958.470637 $97923.5400 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 24 27 25.683334 $642.0900 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1091 1197 1809.410720 $90470.5300 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 100 108 128.660320 $3216.5200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 562 596 921.203575 $46060.2000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 24 27 39.860320 $996.5100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 497 538 843.148816 $42157.4600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 36 72.265480 $1806.6500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1433 1565 2016.949610 $100847.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 110 114 133.367317 $3334.1800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 7 40.333334 $2961.2800 $73.4200
ECE -ECE EARLY CHILDHOOD EDUCATION 4 4 24.714286 $308.9300 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 6 6 51.285714 $1282.1500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 300 344 2179.957156 $54498.8900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 7 214.000000 $10700.0000 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 10 11 5.811112 $290.5600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 21 21 144.880953 $7244.0500 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 8 8 50.571428 $1264.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4279 4825 29065.275518 $1453263.7800 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 24 26 26.105556 $1305.2800 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 47 53 200.469051 $10023.4500 $50.0000
INTR -INTR INTERPRETER 201 267 801.830952 $40091.5500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1954 2212 11006.136932 $747096.5500 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 114 120 612.804765 $33287.5600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 2102 2374 11177.143683 $758704.3900 $67.8800
PHY -97110HM PT SESSION BY PT ASST 95 97 641.795243 $34862.2900 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 526 550 579.915873 $579.9200 $1.0000
SENS -FM FM RECEIVER HEARING AID 4 4 5.000000 $8250.0000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 41 43 67.000000 $33500.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 12 12 14.671233 $953.6300 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 13 14 26.933333 $6140.7900 $228.0000
SENS -V5264 EARMOLD 83 86 112.354639 $2022.3800 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 4 4 5.800000 $290.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 76 83 263.057538 $13152.8900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4425 5013 26011.311732 $1765647.6200 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.500000 $244.4400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 212 226 1546.364284 $20412.0000 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 4 4 23.571429 $2357.1300 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 3198 4573 669773.053988 $334886.5200 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 2.150000 $107.5000 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 51 55 264.163093 $13208.1500 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 9372 26762 763398.236225 $6069820.7300 $7.9500
-------------------------------------------------------------------------------------------------------------------------------------
Total 33324 772668.271152 $6616041.8600 $8.5600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 10661