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 55 59 14.769328 $716.3000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.677778 $29.1400 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 34 34 0.377774 $4.9300 $13.0400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.100000 $1.6800 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 35 35 0.477774 $4.3500 $9.1000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 35 35 0.477774 $4.4600 $9.3300
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 33 33 0.366663 $7.9600 $21.7100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.100000 $2.5300 $25.2600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 2 2 0.855556 $48.7200 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 30 30 0.333330 $8.1500 $24.4400
AUDE -AUDE UNSPECIFIED AUDE SERVICES 23 24 9.638892 $578.3500 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.533333 $24.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 2.038890 $234.4900 $115.0100
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.092466 $4.6200 $49.9600
EXIT -EXIT EXIT ASSESSMENT 52 52 8.474734 $423.7300 $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 1 1 0.161111 $7.8100 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 49 50 14.469843 $701.8000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 35 37 9.188889 $445.6600 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 96 98 43.076186 $2089.1800 $48.5000
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Subtotal (Total Children Is Unduplicated) 382 579 107.620595 $5433.3800 $50.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 17 11.597413 $57987.0000 $4999.9900
AUD -HA_FUP AUDIOLOGY SERVICES 12 12 21.796825 $1089.8500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 501 616 7.666414 $383.7900 $50.0600
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 21 21 0.556911 $13.9300 $25.0200
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1365 1474 2021.753329 $101087.6900 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 30 32 47.199999 $1180.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1214 1312 1791.598088 $89579.8600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 7 5.755557 $143.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1134 1226 1667.436497 $83371.7800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 9 9 14.633333 $365.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1794 1959 2349.302751 $117465.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 26 28 42.355554 $1058.8900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 13 13 63.545206 $1588.6300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 769 870 5224.657991 $261232.7000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 0.428571 $21.4300 $50.0000
INTR -INTR INTERPRETER 37 48 299.454599 $14972.7300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 124 137 706.932146 $47986.5200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 1 1 3.000000 $162.9600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 140 163 730.280950 $49571.4600 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 1.316667 $658.3500 $500.0100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 0.742237 $48.2400 $65.0000
SENS -V5264 EARMOLD 15 15 6.127777 $110.3000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 16 17 17.872222 $893.6100 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 289 323 1726.080947 $117166.2800 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 11.000000 $145.2000 $13.2000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 2437 3824 626023.028352 $313011.5300 $0.5000
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Subtotal (Total Children Is Unduplicated) 3732 12136 642796.120336 $1261297.5500 $1.9600
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Total 12840 643037.075055 $1266730.9300 $1.9700
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Number of Children (Unduplicated) With at Least One Authorization 3962