Summary Report for FSPSAs Initiated During the Report Period Statewide
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.044444 $1.6400 $36.9600
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.750000 $27.7500 $37.0000
TCON -TCON TRANSITION CONFERENCE 4 4 4.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 17 15.794444 $29.3900 $1.8600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 53 57 58.027778 $2814.3500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.311111 $129.4000 $39.0800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 82 85 85.000000 $1008.1000 $11.8600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 8 8 8.000000 $122.0000 $15.2500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 89 92 92.000000 $761.7600 $8.2800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $26.0600 $26.0600
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 90 94 94.000000 $975.7200 $10.3800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 88 91 91.000000 $1918.2800 $21.0800
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $22.9600 $22.9600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 17 17 12.738889 $659.3700 $51.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 64 66 66.000000 $1794.5400 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 224 231 206.619845 $12397.2100 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 25 25 35.992064 $1619.6400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 58 58 64.937061 $7467.7600 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 27 30 55.042857 $6880.3600 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 25 28 9.933331 $496.6600 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 348 372 693.928571 $34696.4300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 7 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 55 55 106.000000 $7950.0000 $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 3 3 5.500000 $412.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 35 38 71.785714 $5383.9300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 62 62 91.636109 $5085.7900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 463 463 908.500000 $68137.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 103 103 189.500000 $14212.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 50 50 98.000000 $7350.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 511 512 712.547197 $39546.2200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 404 430 844.550000 $63341.2500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 16 16 15.545238 $753.9500 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 384 410 363.364287 $17623.1700 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 12 12 24.169047 $1172.2000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 312 327 277.157143 $13442.1200 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 75 82 70.150003 $3507.5200 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 2.000000 $30.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 590 639 594.970641 $28856.1100 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 4 4 8.714286 $871.4300 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 3 3 4.285714 $214.2900 $50.0000
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Subtotal (Total Children Is Unduplicated) 2784 4486 5993.406886 $353643.5600 $59.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 103 113 251.097620 $376646.5500 $1500.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $68.8600 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 86 89 223.107938 $11155.4100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 985 1370 2076.127852 $103806.7000 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 47 50 34.883731 $872.1000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1609 1772 3997.468648 $199873.4600 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 84 85 113.146825 $2828.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 714 763 1273.063096 $63653.1800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 36 38 44.891270 $1122.2800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 736 786 1968.907525 $98445.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 25 27 32.766667 $819.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2020 2164 3490.324583 $174516.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 80 82 118.880953 $2972.0200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 7 22.204763 $1628.0600 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 3 3 68.571428 $857.1400 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 15.333334 $383.3400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 195 197 1409.123816 $35228.0700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 210.285714 $10514.2900 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 0.511111 $25.5600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 21 24 84.200001 $4210.0000 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 3 3 5.001588 $125.0400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4767 5329 30906.174625 $1545308.2000 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 3 3 12.714285 $635.7200 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 67 72 231.357938 $11567.9100 $50.0000
INTR -INTR INTERPRETER 207 289 986.818971 $49340.9300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1126 1274 6696.722613 $454573.4700 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 31 34 185.898809 $10098.0200 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1512 1702 8522.104739 $578480.3800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 44 45 244.874997 $13301.6100 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 397 401 500.934126 $500.9300 $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 16 16 27.282040 $13641.0500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 5.010959 $325.7200 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 8 8 9.511567 $2168.6400 $228.0000
SENS -V5264 EARMOLD 64 68 163.621722 $2945.1900 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 67 71 164.505555 $8225.2900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2302 2607 13827.974072 $938642.6300 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 13.857143 $752.7200 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 68 71 494.123810 $6522.4400 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 8 8 39.161905 $3916.1800 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 4666 7448 1519723.965829 $759861.9900 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 6 6 27.295238 $1364.7700 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 47 53 195.060315 $9753.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 8361 27099 1598422.869721 $5506628.1700 $3.4500
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Total 31602 1604432.071051 $5860301.1300 $3.6500
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Number of Children (Unduplicated) With at Least One Authorization 8894