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 167 180 164.250795 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 167 180 164.250795 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 38 40 9.624508 $466.8000 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 34 34 0.377774 $4.9300 $13.0400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.411111 $6.9000 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 34 34 0.377774 $3.4400 $9.1000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 34 34 0.377774 $3.5300 $9.3300
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 33 33 0.366663 $7.9600 $21.7100
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 2 2 0.749207 $42.6600 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 31 31 0.744441 $18.2100 $24.4600
AUDE -AUDE UNSPECIFIED AUDE SERVICES 21 23 8.010277 $480.6400 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.205556 $9.2500 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 0.950000 $109.2500 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 1 1 0.007534 $0.3800 $49.7700
EXIT -EXIT EXIT ASSESSMENT 36 37 17.137975 $856.8900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 0.027778 $2.0900 $75.0600
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 54 54 0.793581 $59.4800 $74.9500
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 0.033256 $2.4900 $74.8700
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 13 13 0.522479 $29.0000 $55.5100
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 0.033180 $2.4900 $75.0500
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 4 4 0.611112 $29.6400 $48.5100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 46 47 17.155553 $832.0300 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 29 32 7.144445 $346.5100 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 77 80 25.105553 $1217.6100 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 10.285714 $1028.5700 $100.0000
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Subtotal (Total Children Is Unduplicated) 322 516 101.053245 $5560.7300 $55.0300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 21 9.681812 $48409.5000 $5000.0500
AUD -HA_FUP AUDIOLOGY SERVICES 7 7 14.209525 $710.4800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 501 616 6.267099 $313.8200 $50.0700
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 22 22 1.623578 $40.6000 $25.0100
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1249 1427 2041.773706 $102088.7100 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 34 37 47.694444 $1192.3600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1134 1284 1786.667350 $89333.3600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 11.766667 $294.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1033 1160 1619.795242 $80989.7800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 11 11 16.333333 $408.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1673 1905 2355.363765 $117768.2600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 29 31 34.344446 $858.6200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 8 36.885713 $922.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 727 850 4875.505537 $243775.2300 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 5.533333 $276.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 12.428571 $621.4300 $50.0000
INTR -INTR INTERPRETER 36 43 253.263327 $12663.1700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 123 142 678.019047 $46023.9300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 3 3 12.342857 $670.4700 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 129 152 688.215476 $46716.1100 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 5 5 1.427778 $713.9000 $500.0100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 0.727626 $47.2900 $65.0000
SENS -V5264 EARMOLD 7 8 4.544444 $81.8000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 16 17 16.987301 $849.3700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 261 292 1380.654766 $93718.7900 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 0.285714 $3.7700 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.477778 $47.7800 $100.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 2228 3653 554060.394101 $277030.2000 $0.5000
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Subtotal (Total Children Is Unduplicated) 3481 11710 569973.214336 $1166570.0200 $2.0500
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Total 12406 570238.518376 $1172130.7400 $2.0600
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Number of Children (Unduplicated) With at Least One Authorization 3762