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: 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 122 125 133.334124 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 122 125 133.334124 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 66 72 24.241017 $1175.6800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.677778 $29.1400 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 130 130 1.455541 $18.9800 $13.0400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 5 1.788889 $30.0200 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 135 135 3.255541 $29.6400 $9.1100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.011111 $0.2600 $23.4300
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 135 135 3.255541 $30.4000 $9.3400
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.011111 $0.0900 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 130 131 3.516653 $76.3900 $21.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.100000 $2.5300 $25.2600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 11 11 4.032540 $229.6100 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 115 115 1.699987 $41.5700 $24.4500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 99 112 47.648565 $2858.9800 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 12 4.004948 $180.2300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 22 22 12.192467 $1402.1600 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.092466 $4.6200 $49.9600
EXIT -EXIT EXIT ASSESSMENT 54 54 8.819178 $440.9500 $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 8 8 1.083334 $52.5500 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 315 331 97.727298 $4739.7700 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 6 6 1.094445 $53.0800 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 262 279 68.157910 $3305.6400 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 354 371 134.460968 $6521.4100 $48.5000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.444444 $22.2200 $50.0000
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Subtotal (Total Children Is Unduplicated) 1364 2305 423.266846 $21490.2200 $50.7700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 32 35 44.741172 $223705.5000 $4999.9900
AUD -HA_FUP AUDIOLOGY SERVICES 18 18 27.351054 $1367.5600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 506 626 7.709966 $385.9700 $50.0600
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 21 21 0.556911 $13.9300 $25.0200
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1370 1483 2035.619996 $101781.0300 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 30 32 47.199999 $1180.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1215 1314 1792.898088 $89644.8600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 7 5.755557 $143.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1136 1228 1671.669830 $83583.4400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 9 9 14.633333 $365.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1795 1962 2351.802751 $117590.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 26 28 42.355554 $1058.8900 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 8 8 532.428572 $6655.3600 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 88 93 660.554727 $16513.8900 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 0.122222 $6.1100 $49.9900
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2652 2985 18038.625556 $901930.7200 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 17 18 49.350000 $2467.5000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 29 32 132.485319 $6624.2700 $50.0000
INTR -INTR INTERPRETER 37 48 299.454599 $14972.7300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 860 955 4970.383363 $337389.3900 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 6 6 16.771429 $911.0200 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 955 1069 5242.340894 $355850.0600 $67.8800
PHY -97110HM PT SESSION BY PT ASST 11 11 55.495239 $3014.5000 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 8 8 4.176712 $2088.3500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 1.364459 $88.6900 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 8 8 3.808066 $868.2200 $228.0000
SENS -V5264 EARMOLD 44 46 28.004485 $504.0700 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 16 17 56.866667 $2843.3400 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 37 39 70.745239 $3537.2600 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1357 1548 7740.514841 $525425.8100 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.428571 $23.2800 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 43.654762 $576.2400 $13.2000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 2438 3829 627119.933114 $313559.9800 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 18 18 49.775000 $2488.7500 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 23 25 147.102384 $7355.1200 $50.0000
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Subtotal (Total Children Is Unduplicated) 4509 17544 673306.680431 $3126515.6500 $4.6400
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Total 19974 673863.281401 $3148005.8700 $4.6700
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Number of Children (Unduplicated) With at Least One Authorization 4805