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: 10-01-12 and 12-31-12 Date of Report: 02-16-13 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
SCONLY-SCONLY SERVICE COORDINATION ONLY 275 284 2345.251588 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 0.866667 $32.0700 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.005479 $0.2000 $37.1400
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Subtotal (Total Children Is Unduplicated) 276 287 2346.123734 $32.2700 $0.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 83 88 30.144445 $1462.0100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.461111 $62.8100 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 110 112 36.885706 $481.3500 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 2.777778 $46.6100 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 113 115 37.919039 $345.4300 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 111 112 37.907928 $354.0500 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 111 113 37.552372 $815.9900 $21.7300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.377778 $9.5400 $25.2600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 10 10 7.077779 $403.0200 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 92 94 29.030151 $710.3500 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 165 174 342.348711 $20540.9400 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 27 27 17.394900 $782.7700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 50 51 60.291714 $6933.5300 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 4 4 4.000000 $500.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 13 14 3.009589 $150.4800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 133 143 137.575015 $6878.7500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 3 2.008333 $150.6200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 35 35 41.165855 $3087.4400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 0.021916 $1.6500 $75.2900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.019444 $1.4600 $74.8300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 7 0.072145 $5.4100 $74.9500
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 38 40 38.980781 $2163.4300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 184 184 10.064539 $754.7400 $74.9900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 33 33 6.188845 $464.1800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 22 22 0.211108 $15.8100 $74.8900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 57 57 9.383777 $520.8000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 67 68 6.000289 $450.0200 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 20 20 9.887301 $479.5300 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 265 274 172.067949 $8345.2800 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 10 10 1.872222 $90.8000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 224 232 99.270580 $4814.6200 $48.5000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 4 1.167427 $17.5100 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 408 424 247.932559 $12024.7000 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 3 3 1.224353 $61.2200 $50.0000
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 1.000000 $48.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 1542 2486 1434.293439 $73975.3700 $51.5800
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.033333 $41.3300 $40.0000
ASST -ASST ASSISTIVE TECHNOLOGY 69 77 64.528755 $96792.7500 $1499.9900
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 1.144444 $78.8000 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.596032 $109.9000 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 69 69 126.733322 $6336.6900 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 421 541 132.380931 $6619.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 25 27 26.667983 $666.7100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1893 2686 5027.110742 $251355.4800 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 35 35 48.303571 $1207.5900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1401 1509 2686.011647 $134300.5900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 23 27 28.696824 $717.4200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1361 1461 2499.964686 $124998.2300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 14 17.383333 $434.5800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2297 2493 3495.369467 $174768.5400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 44 44 52.781749 $1319.5500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 10 15.209525 $1115.1800 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 2 2 323.142857 $4039.2900 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 4.866667 $121.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 154 165 1105.038095 $27625.9500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 58.866667 $2943.3400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 28.571427 $1428.5800 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 5.200000 $130.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3865 4311 24968.497576 $1248424.6800 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 2.800000 $140.0000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 58 61 277.527356 $13876.3700 $50.0000
INTR -INTR INTERPRETER 84 95 465.933863 $23296.6900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 872 986 4657.647856 $316161.1200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 15 15 47.342857 $2571.6700 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1097 1216 5710.043541 $387597.8800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 43 44 221.778571 $12047.0100 $54.3200
SENS -FM FM RECEIVER HEARING AID 3 3 2.244444 $3703.2600 $1649.9700
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 18 18 18.397947 $9199.0500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 10 7.098782 $461.4200 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 0.250000 $28.5000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 12 12 14.663905 $3343.3500 $228.0000
SENS -V5264 EARMOLD 52 55 60.130570 $1082.3500 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 13 17 56.255555 $2812.7800 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 60 62 137.142864 $6857.1700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1664 1892 9492.931750 $644380.1900 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 25.857143 $1404.5600 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 35 35 225.757146 $2979.9900 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 4004 6643 1087379.050599 $543689.5200 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 8 8 29.353572 $1467.6800 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 71 77 406.599973 $20330.0100 $50.0000
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Subtotal (Total Children Is Unduplicated) 6238 24743 1149957.907927 $4083006.7300 $3.5500
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Total 27516 1153738.325100 $4157014.3700 $3.6000
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Number of Children (Unduplicated) With at Least One Authorization 6926