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 275 283 2345.184921 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 0.866667 $32.0700 $37.0000
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Subtotal (Total Children Is Unduplicated) 275 285 2346.051588 $32.0700 $0.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 74 79 26.372223 $1279.0600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.222222 $52.5400 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 30 31 10.233331 $133.5400 $13.0500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 31 10.233331 $93.2200 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 30 31 10.233331 $95.5800 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 30 31 10.233331 $222.3700 $21.7300
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 7 7 6.583334 $374.8600 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 25 26 9.188887 $224.8500 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 33 34 75.532193 $4531.9400 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 3.866667 $174.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 8 7.589650 $872.8200 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 3 3 1.009589 $50.4800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 128 134 124.255859 $6212.7900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 2.033257 $152.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.008333 $0.6200 $74.7000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.011111 $0.8300 $74.9300
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 2.005479 $111.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 58 58 4.028949 $302.1200 $74.9900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 14 0.133331 $9.9800 $74.8700
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 10 10 0.094290 $5.2300 $55.4400
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 3.565144 $267.3800 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 2.714286 $131.6400 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 56 56 54.083335 $2623.0500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.350000 $16.9800 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 32 33 18.156347 $880.5800 $48.5000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.439649 $6.5900 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 96 99 57.696742 $2798.3100 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 1.046575 $52.3300 $50.0000
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Subtotal (Total Children Is Unduplicated) 520 716 443.920776 $21802.4800 $49.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 32 36 25.851599 $38777.4000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 43 43 79.663861 $3983.2100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 420 540 132.378191 $6619.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 25 27 26.667983 $666.7100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1886 2674 5012.675819 $250633.7200 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 35 35 48.303571 $1207.5900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1392 1500 2667.611648 $133380.5900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 23 27 28.696824 $717.4200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1352 1451 2477.362305 $123868.1200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 14 17.383333 $434.5800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2283 2479 3469.585337 $173479.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 44 44 52.781749 $1319.5500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 3.266667 $239.5100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 25 28 180.123812 $4503.1000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 44.009524 $2200.4800 $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 975 1082 6817.895547 $340894.7100 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 5 6 14.119047 $705.9600 $50.0000
INTR -INTR INTERPRETER 84 95 465.933863 $23296.6900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 146 170 796.888099 $54092.7600 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 5 5 18.209525 $989.1400 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 167 191 854.504361 $58003.7800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 4 4 32.571429 $1769.2800 $54.3200
SENS -FM FM RECEIVER HEARING AID 2 2 2.211111 $3648.3200 $1649.9900
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 7 7 8.159818 $4079.9500 $500.0100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 3.495282 $227.1900 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 3 3.412633 $778.0700 $228.0000
SENS -V5264 EARMOLD 10 11 12.079907 $217.4400 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 0.800000 $40.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 9 9 24.935715 $1246.7900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 349 401 2099.851586 $142537.9200 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 5.571429 $302.6400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 53.171429 $701.8600 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 3989 6589 1075043.150599 $537521.5700 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 1 1 8.857143 $442.8600 $50.0000
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Subtotal (Total Children Is Unduplicated) 5315 17505 1100565.952173 $1915086.0200 $1.7400
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Total 18506 1103355.924537 $1936920.5700 $1.7600
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Number of Children (Unduplicated) With at Least One Authorization 5768