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 162 163 200.008724 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 162 163 200.008724 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 44 52 20.938888 $1015.5300 $48.5000
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) 3 3 0.927778 $52.8300 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 25 26 9.188887 $224.8500 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 22 25 19.911189 $1194.6800 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.855555 $128.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 4.272070 $491.2900 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.009589 $0.4800 $50.0600
EXIT -EXIT EXIT ASSESSMENT 64 68 61.082887 $3054.1500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 0.033257 $2.5000 $75.1000
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 1 1 0.005479 $0.3100 $55.7000
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 3 3 0.672222 $32.6000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 44 44 12.724280 $617.1400 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 3 0.550000 $26.6800 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 25 26 6.833334 $331.4200 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 78 79 24.323017 $1179.6700 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.161111 $16.1100 $99.9900
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Subtotal (Total Children Is Unduplicated) 382 562 213.264025 $9499.6000 $44.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 14 7.625114 $11437.6500 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 16 16 61.916514 $3095.8400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 401 504 78.531269 $3926.9200 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 21 22 6.844175 $171.1200 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1315 1725 2881.169428 $144058.4400 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 27 27 45.583332 $1139.5800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1140 1226 1973.905850 $98695.2900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 15 18 26.788888 $669.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1048 1118 1771.349207 $88567.4500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 9 9 14.649999 $366.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1635 1763 2693.948809 $134697.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 26 26 33.287302 $832.1800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.800000 $58.6600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 8 56.933335 $1423.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 724 801 5802.210349 $290110.5100 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 2 2 1.300000 $65.0000 $50.0000
INTR -INTR INTERPRETER 43 50 272.365609 $13618.2800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 126 147 747.823021 $50762.2700 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 3 3 8.790475 $477.5000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 134 160 720.807144 $48928.3900 $67.8800
PHY -97110HM PT SESSION BY PT ASST 1 1 10.714286 $582.0000 $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 4 4 2.838889 $1419.4500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 1.091629 $70.9500 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 2.166666 $493.9800 $227.9900
SENS -V5264 EARMOLD 8 9 6.349847 $114.3000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 5 5 7.238096 $361.9100 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 280 321 1794.677777 $121822.7500 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 10.000000 $132.0000 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 2 2 22.428572 $2242.8500 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 2456 3983 794098.147722 $397049.0700 $0.5000
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Subtotal (Total Children Is Unduplicated) 3675 11972 813162.349971 $1417501.0800 $1.7400
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Total 12697 813575.622720 $1427000.6800 $1.7500
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Number of Children (Unduplicated) With at Least One Authorization 3948