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: 01-01-13 and 03-31-13 Date of Report: 05-17-13 Page: 1
Child has a MEDICAID # Filter: Y
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 140 150 130.728572 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 140 150 130.728572 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 37 39 9.341174 $453.0600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.322222 $13.8500 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 88 88 0.988879 $12.9000 $13.0400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 0.600000 $10.0700 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 90 90 1.599990 $14.5700 $9.1000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 90 90 1.599990 $14.9400 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 87 87 1.566657 $34.0200 $21.7200
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 3 3 0.683333 $38.9100 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 79 79 1.383324 $33.8300 $24.4500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 67 77 38.661118 $2319.7100 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 7 1.008599 $45.3800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 5.661644 $651.0800 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 0.007534 $0.3800 $49.7700
EXIT -EXIT EXIT ASSESSMENT 26 26 12.621003 $631.0500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 0.055479 $4.1600 $75.0300
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 0.016590 $1.2500 $75.0500
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.016590 $1.2500 $75.0500
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 0.022069 $1.2300 $55.5700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 122 122 1.011774 $75.8600 $74.9700
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 0.120813 $9.0700 $75.0500
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 49 49 0.292989 $16.2800 $55.5700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 42 42 0.292686 $21.9500 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 10 10 2.855557 $138.5000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 206 216 84.370720 $4091.9700 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 6 6 0.877778 $42.5700 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 164 176 41.290886 $2002.5900 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 194 203 61.976485 $3005.8700 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 10.757936 $1075.7900 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.055556 $2.7800 $50.0400
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Subtotal (Total Children Is Unduplicated) 847 1467 280.059375 $14764.8500 $52.7200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 25 22.754033 $113770.0000 $4999.9900
AUD -HA_FUP AUDIOLOGY SERVICES 7 7 11.352382 $567.6300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 317 392 4.528501 $226.7400 $50.0700
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 16 16 1.611077 $40.2900 $25.0100
CONIF -CONIF CONSULT ITDS, FACE TO FACE 817 930 1348.857829 $67442.9000 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 28 29 37.466667 $936.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 727 820 1117.670959 $55883.5500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 11.766667 $294.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 686 770 1046.991275 $52349.5900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 9 9 12.966667 $324.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1072 1216 1412.811114 $70640.6100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 22 24 24.327779 $608.2000 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 8 8 796.857142 $9960.7100 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 99 110 772.466654 $19311.6900 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 6 6 3.744444 $187.2200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1812 2130 12402.021338 $620101.2700 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 10 10 60.183333 $3009.1700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 18 21 82.315871 $4115.8000 $50.0000
INTR -INTR INTERPRETER 33 40 252.313327 $12615.6700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 595 674 3265.588872 $221668.1300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 4 4 6.857142 $372.4800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 676 765 3317.586879 $225197.8800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 5 5 8.428571 $457.8400 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 1.411111 $705.5500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 0.760959 $49.4600 $64.9900
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 6 6 1.517199 $345.9000 $227.9900
SENS -V5264 EARMOLD 18 20 13.088888 $235.6000 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 10 13 40.094445 $2004.7300 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 28 28 61.403968 $3070.2000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 744 853 4020.864453 $272936.3400 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 1.428571 $77.6000 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 29.802381 $393.3900 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.477778 $47.7800 $100.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 1621 2603 360651.387238 $180325.6900 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 11 13 38.897222 $1944.8600 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 20 22 91.992854 $4599.6400 $50.0000
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Subtotal (Total Children Is Unduplicated) 2992 11595 390974.595590 $1946819.0700 $4.9800
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Total 13212 391385.383537 $1961583.9100 $5.0100
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Number of Children (Unduplicated) With at Least One Authorization 3366