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: 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 163 164 201.075391 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.005479 $0.2000 $37.1400
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Subtotal (Total Children Is Unduplicated) 164 165 201.080870 $0.2000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 47 56 22.349999 $1083.9700 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 109 111 35.130150 $458.4400 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.600000 $10.0700 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 111 113 35.741261 $325.5900 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 110 111 35.943849 $335.7100 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 111 113 35.966071 $781.5200 $21.7300
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 13 13 3.312024 $188.5800 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 92 94 29.030151 $710.3500 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 101 108 211.316596 $12679.0300 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 15 15 8.297639 $373.3900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 26 26 16.757914 $1927.1500 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 3 3 0.065145 $3.2600 $50.0400
EXIT -EXIT EXIT ASSESSMENT 68 74 64.438442 $3221.9200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 0.375456 $28.1600 $74.9900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 14 14 3.947830 $296.0900 $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 18 19 4.553688 $252.7300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 185 185 10.275650 $770.5700 $74.9900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 34 34 6.399956 $480.0100 $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 8.445238 $409.6000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 262 270 96.401354 $4675.4800 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 11 11 12.443651 $603.5100 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 191 198 63.304404 $3070.2700 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 320 333 109.439250 $5307.8100 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.161111 $16.1100 $99.9900
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.177778 $8.8900 $50.0100
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Subtotal (Total Children Is Unduplicated) 1279 2086 830.583286 $39013.3500 $46.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 39 44 47.610044 $71414.8500 $1500.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.433333 $29.8400 $68.8500
AUD -HA_FUP AUDIOLOGY SERVICES 29 30 90.117232 $4505.8800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 402 506 88.962580 $4448.4900 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 21 22 6.844175 $171.1200 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1318 1734 2898.586094 $144929.2700 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 27 27 45.583332 $1139.5800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1142 1228 1975.789183 $98789.4500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 15 18 26.788888 $669.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1052 1123 1776.532539 $88826.6100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 9 9 14.649999 $366.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1637 1765 2696.215475 $134810.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 27 27 35.487302 $887.1800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 4 10.076190 $738.7900 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 4 4 93.571430 $1169.6400 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 107 109 823.166678 $20579.1500 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 0.344444 $17.2200 $49.9900
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2603 2887 20251.906771 $1012595.2800 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 20 20 94.591667 $4729.5900 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 28 31 139.446404 $6972.3300 $50.0000
INTR -INTR INTERPRETER 43 50 272.365609 $13618.2800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 790 878 4936.551217 $335093.0800 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 12 12 65.300001 $3547.1000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 872 976 5078.442805 $344724.6600 $67.8800
PHY -97110HM PT SESSION BY PT ASST 20 20 107.290477 $5828.0200 $54.3200
SENS -FM FM RECEIVER HEARING AID 1 1 0.066667 $110.0600 $1650.8200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 10 10 6.357914 $3178.9000 $499.9900
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 2.947185 $191.5700 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 7 7 5.761948 $1313.7100 $228.0000
SENS -V5264 EARMOLD 30 33 26.541625 $477.7400 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 13 19 40.200000 $2010.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 29 29 73.419049 $3670.9600 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1298 1486 8363.404010 $567707.7300 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 7.000000 $380.2400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 8 9 58.623810 $773.8300 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 2 2 22.428572 $2242.8500 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2472 4010 800027.438992 $400013.7200 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 20 20 91.782143 $4589.1100 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 36 39 183.718626 $9185.9300 $50.0000
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Subtotal (Total Children Is Unduplicated) 4450 17198 850486.344410 $3296448.4000 $3.8800
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Total 19449 851518.008566 $3335461.9600 $3.9200
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Number of Children (Unduplicated) With at Least One Authorization 4798