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: 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 0.355556 $13.1600 $37.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.355556 $13.1600 $37.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 73 77 70.257147 $3407.4900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.266667 $10.4200 $39.0800
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) 5 5 15.794444 $817.5200 $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 36 39 33.672223 $2020.3400 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 9 6.938812 $797.9600 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 2 2 2.000000 $250.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 11 11 18.000000 $900.0000 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 297 317 586.066666 $29303.3300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $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 7 7 9.019444 $500.5800 $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
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 6 6 2.749999 $133.3700 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 38 39 29.144444 $1413.5000 $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 36 37 31.811904 $1542.8800 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 29 29 34.055560 $1702.8000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.600000 $9.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 60 64 52.497616 $2546.1200 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 4 4 9.000000 $450.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 743 1045 1387.308252 $68336.7100 $49.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 41 44 36.983333 $55474.9500 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 39 40 89.767459 $4488.3800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 648 805 509.822782 $25491.4800 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 32 34 33.207740 $830.1900 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2002 2478 3931.991670 $196599.6000 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 43 44 86.604762 $2165.1200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1552 1709 2263.519849 $113176.0300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 18 18 30.141666 $753.5400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1544 1702 2290.164298 $114508.2900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 16 16 22.174999 $554.3700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2496 2745 3410.659131 $170532.9900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 47 47 91.163494 $2279.1000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 33 33 241.476188 $6036.9100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 43.866667 $2193.3400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 18.000000 $900.0000 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 2 2 8.400000 $210.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 991 1118 7946.459909 $397322.9100 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 5 5 13.609523 $680.4800 $50.0000
INTR -INTR INTERPRETER 170 236 968.574610 $48428.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 163 178 841.157141 $57097.7200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 6 6 34.219048 $1858.7800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 181 204 850.097616 $57704.6000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 7 7 39.214286 $2130.1200 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 292 298 2714.909521 $2714.9100 $1.0000
SENS -FM FM RECEIVER HEARING AID 1 1 1.333333 $2199.9500 $1649.9600
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 6 6 5.555479 $2777.7500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 7 6.600000 $429.0000 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 0.600000 $68.4000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 0.788889 $179.8700 $228.0000
SENS -V5264 EARMOLD 11 11 8.605479 $154.9000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 9 9 8.590476 $429.5300 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 395 422 2458.823815 $166904.9700 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 14 14 63.387299 $836.7100 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 5 5 27.857144 $2785.7100 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 4410 6843 1311966.582560 $655983.3000 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 11.042857 $552.1500 $50.0000
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Subtotal (Total Children Is Unduplicated) 6249 19100 1341075.953023 $2097434.7100 $1.5600
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Total 20146 1342463.616831 $2165784.5800 $1.6100
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Number of Children (Unduplicated) With at Least One Authorization 6522