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: 01-01-12 and 03-31-12 Date of Report: 05-15-12 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
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 11 11 11.000000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 6 6 14.349207 $530.9200 $37.0000
TCON -TCON TRANSITION CONFERENCE 4 4 4.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 21 29.349207 $530.9200 $18.0900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 57 59 60.652381 $2941.6400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.711111 $27.7900 $39.0800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 82 85 85.000000 $1008.1000 $11.8600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 4.000000 $61.0000 $15.2500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 84 87 87.000000 $720.3600 $8.2800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $26.0600 $26.0600
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 87 91 91.000000 $944.5800 $10.3800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.300000 $2.4300 $8.1000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 85 88 88.000000 $1855.0400 $21.0800
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 7 7 7.000000 $362.3200 $51.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 64 66 66.000000 $1794.5400 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 223 230 204.007941 $12240.5000 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 29 29 29.344444 $1320.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 59 59 68.761112 $7907.5400 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 4 4 9.304761 $1163.0900 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 41 44 69.000000 $8625.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 32 36 19.341268 $967.0600 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 334 353 664.142857 $33207.1400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 45 45 88.000000 $6600.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 15.500000 $1162.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 9.500000 $712.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 42 45 82.785714 $6208.9300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 57 58 88.207538 $4895.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 483 483 948.500000 $71137.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 106 106 195.500000 $14662.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 68 68 134.000000 $10050.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 527 528 744.547197 $41322.2200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 428 455 904.835714 $67862.6900 $75.0000
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 4 4 4.000000 $200.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 31 32 21.928572 $1063.5400 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 405 426 414.492065 $20102.8800 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 26 26 22.144445 $1074.0100 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 335 356 347.450000 $16851.3300 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 69 69 64.316668 $3215.8400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.088889 $16.3300 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 688 740 733.396826 $35569.7400 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 1.000000 $100.0000 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 5 5 9.285714 $464.2900 $50.0000
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Subtotal (Total Children Is Unduplicated) 2907 4707 6385.045217 $378446.9800 $59.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 95 107 203.588889 $305383.3500 $1500.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 2.533333 $174.4400 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 83 87 144.071430 $7203.5700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1062 1487 2324.572034 $116229.0400 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 46 49 36.544049 $913.6000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1315 1465 4392.562303 $219628.1200 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 69 73 111.989684 $2799.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 583 626 1668.574608 $83428.7700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 41 41 50.792462 $1269.8200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 564 606 1887.157537 $94357.8400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 28 28 55.707143 $1392.6800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1729 1886 3990.597408 $199529.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 72 72 80.207541 $2005.1900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 6 7 8.603175 $630.7900 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 5 5 844.285714 $10553.5700 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 242 259 1696.880950 $42422.0300 $25.0000
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 2 2 7.866667 $393.3400 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 11 11 84.999998 $4250.0100 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 0.500000 $25.0000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 12 13 31.333333 $1566.6700 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 13 13 59.077780 $1476.9400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4450 5112 30032.735038 $1501636.6200 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 3 3 9.819048 $490.9500 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 65 70 317.920636 $15896.0200 $50.0000
INTR -INTR INTERPRETER 219 290 1188.977701 $59448.8700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1287 1444 7001.524227 $475263.5200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 42 43 206.308335 $11206.6800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1648 1868 8467.246045 $574756.5100 $67.8800
PHY -97110HM PT SESSION BY PT ASST 54 56 284.371426 $15447.0600 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 458 470 526.775398 $526.7800 $1.0000
SENS -FM FM RECEIVER HEARING AID 4 4 6.000000 $9900.0000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 19 19 27.000000 $13500.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 6.522222 $423.9400 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 7 7 10.683334 $2435.8200 $228.0000
SENS -V5264 EARMOLD 65 67 72.983332 $1313.7000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 86 92 258.402380 $12920.1300 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2560 2906 14824.312237 $1006273.8900 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 27.771429 $1508.5400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 60 61 423.392854 $5588.7900 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 3 3 7.000000 $700.0000 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 3752 5487 1068799.048498 $534399.5300 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 6 6 28.428572 $1421.4300 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 51 56 204.071826 $10203.5900 $50.0000
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Subtotal (Total Children Is Unduplicated) 8365 24915 1150413.740576 $5350896.7400 $4.6500
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Total 29643 1156828.135000 $5729874.6400 $4.9500
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Number of Children (Unduplicated) With at Least One Authorization 9307