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: 07-01-12 and 09-30-12 Date of Report: 11-15-12 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.177778 $6.5800 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 2.550000 $94.3500 $37.0000
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Subtotal (Total Children Is Unduplicated) 4 4 2.727778 $100.9300 $37.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 58 69 57.313489 $2779.6900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.688889 $72.6100 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 80 80 80.000000 $1044.0000 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 6 6 5.250000 $88.1000 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 87 87 84.661112 $771.2600 $9.1100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.4500 $23.4500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 85 85 84.250000 $786.9000 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 88 88 87.250000 $1895.9400 $21.7300
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 16 16 13.466667 $766.7900 $56.9400
AUDE -92586 AUD EVOKED RESPONSE (SCREEN) 1 1 1.000000 $33.5400 $33.5400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 56 56 56.000000 $1370.3200 $24.4700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $27.2800 $27.2800
AUDE -AUDE UNSPECIFIED AUDE SERVICES 199 210 175.552385 $10533.1700 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 20 20 18.191478 $818.6200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 46 47 50.077548 $5758.9200 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 4 4 17.571429 $2196.4300 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 37 42 44.683334 $2234.1700 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 333 363 650.938446 $32546.8800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 7 9.066667 $680.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 36 36 66.005479 $4950.4100 $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 11 12 21.511111 $1613.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 38 38 67.016590 $3719.4200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 358 358 642.680245 $48200.9900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 73 73 131.066667 $9830.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 26.000000 $1950.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 320 323 616.594214 $34220.9800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 247 297 571.072145 $42830.4100 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 23 24 12.994444 $630.2300 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 312 329 274.296030 $13303.3500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 9 9 5.547620 $269.0600 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 260 281 218.468258 $10595.7300 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 48 48 76.055560 $3802.8000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 5.533333 $83.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 389 403 335.635195 $16278.3200 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 1.000000 $100.0000 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 4.000000 $200.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 2160 3436 4516.938335 $257243.6000 $56.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 80 87 223.894444 $335841.6000 $1500.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $68.8600 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $68.8600 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 62 63 81.894444 $4094.7200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 657 797 403.892432 $20194.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 28 28 13.898216 $347.4600 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1417 1846 3211.678978 $160583.9800 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 63 67 128.689682 $3217.2400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 979 1093 1855.037721 $92752.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 18 19 27.775000 $694.3800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 975 1078 1739.088502 $86954.4800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 12 12 15.177777 $379.4400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1830 2029 2788.428974 $139421.4900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 56 59 74.540474 $1863.5100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 13 14 54.614286 $4004.3200 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 19.285714 $241.0700 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 2 3.866666 $96.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 158 183 1150.380948 $28759.5400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 116.428572 $5821.4300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 3 12.999999 $650.0100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4035 4683 28936.573839 $1446829.1300 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 2 3 14.500001 $725.0000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 53 54 243.696828 $12184.8500 $50.0000
INTR -INTR INTERPRETER 152 225 875.482104 $43774.1200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 911 1053 5399.175789 $366496.2300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 30 33 191.660714 $10411.0100 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1177 1343 6706.462936 $455234.8000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 35 38 165.908333 $9012.1300 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 332 354 3186.747620 $3186.7500 $1.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 13 14 18.195129 $9097.6000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 10.533333 $684.6600 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 3.533333 $402.8000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 7 7 6.749086 $1538.7900 $228.0000
SENS -V5264 EARMOLD 46 47 55.106241 $991.9200 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 1.650000 $82.5000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 54 57 159.016670 $7950.8400 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1730 1948 10356.165899 $702976.5600 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 5.142857 $279.3600 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 38 41 231.604766 $3057.1800 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 3 3 16.233333 $1623.3300 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 4166 6739 1141527.132177 $570763.5700 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 5 6 16.415079 $820.7600 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 40 47 201.842856 $10092.1600 $50.0000
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Subtotal (Total Children Is Unduplicated) 6978 24093 1210253.101752 $4544272.0100 $3.7500
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Total 27533 1214772.767865 $4801616.5400 $3.9500
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Number of Children (Unduplicated) With at Least One Authorization 7607