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
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 168 181 164.750795 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 168 181 164.750795 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 49 51 17.463398 $846.9900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.322222 $13.8500 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 130 130 1.455541 $18.9800 $13.0400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 0.968949 $16.2600 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 134 134 2.472207 $22.5100 $9.1000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.011111 $0.2600 $23.4300
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 135 135 2.658508 $24.8200 $9.3400
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.011111 $0.0900 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 131 131 2.577458 $55.9800 $21.7200
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 7 7 1.876984 $106.8700 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 116 116 1.855542 $45.3700 $24.4500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 99 114 52.088063 $3125.3500 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 12 2.169710 $97.6300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 21 21 7.567581 $870.2700 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.135312 $6.7700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 36 37 17.137975 $856.8900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 0.086034 $6.4500 $74.9700
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 0.024923 $1.8700 $74.9300
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 191 191 1.889104 $141.6200 $74.9600
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 36 36 0.210537 $15.8000 $75.0200
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 73 73 0.889855 $49.4200 $55.5400
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 52 52 0.356002 $26.7100 $75.0200
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 14 14 3.238891 $157.1000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 300 318 109.292941 $5300.7000 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 7 7 1.055556 $51.2000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 246 265 63.049944 $3057.9200 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 353 374 114.741032 $5564.9600 $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) 1292 2247 416.458642 $21563.6500 $51.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 38 45 38.530747 $192655.0000 $5000.0300
AUD -HA_FUP AUDIOLOGY SERVICES 16 16 27.842858 $1392.1500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 506 626 6.310651 $316.0000 $50.0700
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 22 22 1.623578 $40.6000 $25.0100
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1254 1435 2053.607039 $102680.3700 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 34 37 47.694444 $1192.3600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1138 1289 1792.400683 $89620.0300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 11.766667 $294.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1037 1164 1623.628575 $81181.4400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 11 11 16.333333 $408.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1676 1910 2361.230431 $118061.5900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 29 31 34.344446 $858.6200 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 9 9 840.428571 $10505.3600 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 118 129 952.314271 $23807.8800 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 7 7 4.000000 $200.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2447 2871 16733.144343 $836657.3600 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 18 19 98.508333 $4925.4200 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 27 30 123.030155 $6151.5200 $50.0000
INTR -INTR INTERPRETER 36 43 253.263327 $12663.1700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 847 969 4763.652749 $323356.6800 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 5 5 15.571428 $845.8400 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 940 1075 4816.670199 $326955.7500 $67.8800
PHY -97110HM PT SESSION BY PT ASST 7 7 14.428571 $783.7600 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 10 10 3.067048 $1533.5500 $500.0100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 1.516515 $98.5700 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 7 7 1.683866 $383.9100 $227.9900
SENS -V5264 EARMOLD 33 36 21.955555 $395.2000 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 13 17 53.994445 $2699.7300 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 40 41 74.227778 $3711.4000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1302 1504 7339.850889 $498229.0200 $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 9 9 35.773809 $472.2200 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.477778 $47.7800 $100.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 2233 3664 555896.435371 $277948.2200 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 13 15 49.997222 $2499.8600 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 26 28 122.130949 $6106.5500 $50.0000
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Subtotal (Total Children Is Unduplicated) 4296 17098 600232.865195 $2929756.9600 $4.8800
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Total 19526 600814.074632 $2951320.6100 $4.9100
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Number of Children (Unduplicated) With at Least One Authorization 4819