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: 04-01-12 and 06-30-12 Date of Report: 08-16-12 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 2.714286 $100.4300 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 16.533333 $611.7300 $37.0000
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Subtotal (Total Children Is Unduplicated) 2 2 19.247619 $712.1600 $37.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 46 47 55.607144 $2696.9500 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 42 42 42.000000 $498.1200 $11.8600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 42 42 42.000000 $347.7600 $8.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 43 43 43.000000 $446.3400 $10.3800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 43 43 43.000000 $906.4400 $21.0800
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $22.9600 $22.9600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 1 1 1.000000 $51.7600 $51.7600
AUDE -92586 AUD EVOKED RESPONSE (SCREEN) 1 1 1.000000 $30.4900 $30.4900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 37 37 37.000000 $1006.0300 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 30 32 28.088888 $1685.3300 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 7.277778 $836.9500 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 2 2 2.000000 $250.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 11 11 19.000000 $950.0000 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 287 312 568.709523 $28435.4800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 9 13.019444 $722.5800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 38 38 74.500000 $5587.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 8 8 14.500000 $1087.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 81 81 71.933326 $3992.2600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 42 52 99.500000 $7462.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 1 1 1.000000 $50.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 7 7 1.916666 $92.9600 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 50 51 50.394445 $2444.1300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 1.000000 $48.5000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 33 35 30.000794 $1455.0400 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 30 30 34.955560 $1747.8000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 77 83 73.063492 $3543.5800 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 1.000000 $100.0000 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 4 4 12.000000 $600.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 726 1031 1384.467060 $68108.9400 $49.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 32 33 32.122221 $48183.1500 $1499.9900
AUD -HA_FUP AUDIOLOGY SERVICES 36 37 67.457142 $3372.8600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 888 1303 1849.974852 $92499.0700 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 27 28 16.283930 $407.1000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1495 1697 4085.984135 $204299.1800 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 67 75 89.668254 $2241.7100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 668 719 1371.717476 $68585.9000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 24 24 36.743253 $918.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 770 823 2004.089691 $100204.4800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 36 38 45.011508 $1125.2900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1895 2082 3639.196433 $181959.8000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 70 75 88.621826 $2215.5500 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 185.714286 $2321.4300 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 11.904762 $297.6200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 29 29 181.780951 $4544.5300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 119.999999 $6000.0100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 19.152380 $957.6200 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 4 4 8.300000 $207.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1107 1244 7373.561122 $368678.0700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 4 4 16.019048 $800.9500 $50.0000
INTR -INTR INTERPRETER 166 227 838.742859 $41937.1300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 194 215 1021.997621 $69373.2000 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 5 5 15.895239 $863.4300 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 218 250 1126.871429 $76492.0000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 6 6 36.685714 $1992.7700 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 358 377 604.398413 $604.4000 $1.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 5.900000 $2950.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 3.208219 $208.5300 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 1.922222 $438.2600 $228.0000
SENS -V5264 EARMOLD 11 11 14.500000 $261.0000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 6 6 8.033333 $401.6700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 540 592 2898.379368 $196742.0300 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 13 13 76.795237 $1013.7000 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 2 2 4.142857 $414.2900 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 4033 6036 1314890.214224 $657445.1100 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 9.571429 $478.5700 $50.0000
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Subtotal (Total Children Is Unduplicated) 6216 15980 1342801.561433 $2141550.4400 $1.5900
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Total 17013 1344205.276112 $2210371.5500 $1.6400
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Number of Children (Unduplicated) With at Least One Authorization 6540