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: 10-01-11 and 12-31-11 Date of Report: 02-15-12 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
TCM -T1017TL TARGETED CASE MANAGEMENT 10 10 14.705557 $544.1100 $37.0000
TCON -TCON TRANSITION CONFERENCE 1 1 1.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 11 15.705557 $544.1100 $34.6400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 43 43 48.000000 $2328.0000 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 102 103 101.571428 $1204.6400 $11.8600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 7 7 7.000000 $106.7500 $15.2500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 107 108 106.571428 $882.4100 $8.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 109 110 107.649206 $1117.4000 $10.3800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 108 109 106.649206 $2248.1700 $21.0800
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $22.9600 $22.9600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 13 13 13.000000 $672.8800 $51.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 74 75 74.285714 $2019.8300 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 236 248 240.133334 $14408.0000 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 40 40 51.000000 $2295.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 74 75 84.300001 $9694.5100 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 9 9 22.147619 $2768.4500 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 46 49 86.166666 $10770.8300 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 28 29 37.076190 $1853.8100 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 344 365 681.283333 $34064.1700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 42 42 81.000000 $6075.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 9.500000 $712.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 6.000000 $450.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 30 31 59.000000 $4425.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 62 68 115.508220 $6410.7100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 372 372 727.000000 $54525.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 139 140 262.000000 $19650.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 67 68 134.500000 $10087.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 388 389 748.500000 $41541.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 424 467 926.533333 $69490.0000 $75.0000
MED -MED UNSPECIFIED MED OFFICE VISIT 2 2 2.000000 $300.0000 $150.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.000000 $100.0000 $50.0000
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 3 3 3.000000 $150.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 55 57 61.571429 $2986.2100 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 460 491 494.057143 $23961.7700 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 54 56 56.000000 $2716.0000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 388 401 434.570637 $21076.6800 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 25 27 27.000000 $1350.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 3.000000 $45.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 782 825 920.637293 $44650.9100 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 3.000000 $300.0000 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 3 3 4.000000 $200.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3035 4841 6848.212180 $397661.8200 $58.0700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 128 138 305.142857 $457714.3500 $1500.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.488889 $102.5300 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 112 116 209.550791 $10477.5300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 903 1309 1989.418972 $99470.9700 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 42 44 39.276192 $981.9100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1235 1359 2036.280151 $101813.9600 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 51 54 72.650393 $1816.2600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 547 581 852.426202 $42621.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 21 23 38.639682 $965.9900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 535 573 963.931743 $48196.5800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 32 32 47.451189 $1186.2800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1604 1753 2194.597236 $109729.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 81 83 123.863490 $3096.5800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 8 26.776190 $1963.2300 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 2 2 61.000000 $762.5000 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 13.571429 $339.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 237 257 1676.409526 $41910.2400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 12 91.895239 $4594.7600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 7 7 44.857142 $2242.8500 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 7 7 24.000000 $600.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4140 4603 26945.874321 $1347293.2700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 39 40 213.342855 $10667.1400 $50.0000
INTR -INTR INTERPRETER 216 303 1110.255959 $55512.7800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1269 1426 7315.180965 $496554.4200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 56 58 358.314285 $19463.6400 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1660 1859 8316.836161 $564546.7000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 37 41 172.585716 $9374.8700 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 470 487 504.160317 $504.1600 $1.0000
SENS -FM FM RECEIVER HEARING AID 2 2 3.000000 $4950.0000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 23 23 34.000000 $17000.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 13 13 15.361644 $998.5000 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 3 3 3.000000 $342.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 8 8 14.000000 $3192.0000 $228.0000
SENS -V5264 EARMOLD 67 69 83.611111 $1505.0000 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 1.000000 $50.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 76 77 171.780158 $8589.0100 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2736 3060 15196.667100 $1031549.5800 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 30.990476 $1683.4000 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 78 80 531.207141 $7011.9400 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 1.000000 $100.0000 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 3151 4441 785938.304806 $392969.1600 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 5 5 14.254762 $712.7400 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 46 50 200.687703 $10034.3900 $50.0000
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Subtotal (Total Children Is Unduplicated) 8128 23015 857988.642793 $4915191.7200 $5.7300
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Total 27867 864852.560530 $5313397.6500 $6.1400
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Number of Children (Unduplicated) With at Least One Authorization 9050