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
TCON -TCON TRANSITION CONFERENCE 3 3 3.000000 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 13 15 14.044444 $1.6400 $0.1200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 37 39 39.027778 $1892.8500 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 19 20 20.000000 $237.2000 $11.8600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 19 20 20.000000 $165.6000 $8.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 19 20 20.000000 $207.6000 $10.3800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 19 20 20.000000 $421.6000 $21.0800
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 5 5 3.388889 $175.4100 $51.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 18 18 18.000000 $489.4200 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 24 24 19.944444 $1196.6600 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.188889 $53.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 2.199999 $252.9900 $114.9900
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 5 5 9.000000 $1125.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 3.000000 $150.0000 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 305 329 614.928571 $30746.4300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 7.500000 $562.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 13 13 8.094443 $449.2300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 67 67 131.500000 $9862.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 12 12 21.000000 $1575.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 14.000000 $1050.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 141 141 113.833318 $6317.6600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 72 76 149.500000 $11212.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 4 4 6.595238 $319.8700 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 52 54 48.955555 $2374.3400 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 2.000000 $97.0000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 25 26 19.466667 $944.1400 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 10 11 9.105556 $455.2800 $50.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 102 105 102.484920 $4970.5200 $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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 788 1044 1446.214267 $79003.0200 $54.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 33 34 30.050001 $45075.1500 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 43 44 99.174604 $4958.7300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 965 1346 2045.377852 $102269.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 47 50 34.883731 $872.1000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1597 1757 3947.382935 $197369.1800 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 84 85 113.146825 $2828.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 687 731 1224.334524 $61216.7600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 35 37 44.524603 $1113.1200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 716 764 1929.040858 $96452.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 25 27 32.766667 $819.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1995 2134 3447.799189 $172389.9100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 79 81 118.447620 $2961.1900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 7.466667 $186.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 32 33 289.552383 $7238.8100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 210.285714 $10514.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 8 9 34.571430 $1728.5700 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 3.866667 $96.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1103 1233 7655.352386 $382767.5500 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 6.428571 $321.4300 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 6 6 13.658731 $682.9400 $50.0000
INTR -INTR INTERPRETER 207 289 986.818971 $49340.9300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 170 187 998.974609 $67810.4400 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 2 2 9.571429 $519.9200 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 194 219 1055.123810 $71621.8000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 6 6 32.214285 $1749.8800 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 393 396 495.934126 $495.9300 $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 5 5 5.322222 $2661.1000 $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 1 1 0.433333 $98.7900 $227.9800
SENS -V5264 EARMOLD 14 14 15.155556 $272.8000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 13 13 20.514285 $1025.7100 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 445 491 2700.504749 $183310.2500 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 12 12 59.452381 $784.7700 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 8 8 39.161905 $3916.1800 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 4635 7384 1513634.065830 $756817.0400 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 16.000000 $800.0000 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6597 17417 1541365.370408 $2238363.3300 $1.4500
-------------------------------------------------------------------------------------------------------------------------------------
Total 18476 1542825.629119 $2317367.9900 $1.5000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 6883