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: 04-01-13 and 06-30-13 Date of Report: 08-18-13 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 148 153 147.733332 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 148 153 147.733332 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 52 58 13.331202 $646.5600 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 102 103 25.888880 $337.8400 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 0.600000 $10.0700 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 104 105 24.877769 $226.6300 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 105 105 24.877769 $232.3500 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 103 104 24.688880 $536.4700 $21.7300
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 13 13 3.100000 $176.5100 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 79 80 18.699993 $457.5700 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 105 110 104.709743 $6282.5900 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 13 5.500001 $247.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 20 20 7.835160 $901.0500 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 4 4 0.213698 $10.6900 $50.0200
EXIT -EXIT EXIT ASSESSMENT 63 63 10.022910 $501.1400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 8 8 0.083179 $6.2300 $74.9300
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 0.019291 $1.4500 $75.0300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.022222 $1.6700 $74.9300
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 0.010958 $0.6100 $55.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 192 192 2.369595 $177.7400 $75.0100
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 45 45 1.043146 $78.2700 $75.0300
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 0.005556 $0.4200 $75.5900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 105 105 0.824374 $45.8100 $55.5600
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 46 46 0.346798 $26.0200 $75.0200
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 14 16 2.661112 $129.0700 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 285 312 91.036931 $4415.2700 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 15 16 4.788639 $232.2500 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 251 267 74.889280 $3632.1300 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 320 335 84.024452 $4075.1900 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.355556 $35.5600 $100.0100
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Subtotal (Total Children Is Unduplicated) 1311 2131 526.827094 $23424.6500 $44.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 37 40 14.207002 $71035.0000 $5000.0000
AUD -HA_FUP AUDIOLOGY SERVICES 20 20 22.936531 $1146.8300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 500 632 26.865231 $1343.7900 $50.0200
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 29 29 1.494280 $37.3700 $25.0100
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1378 1763 2035.784952 $101789.2500 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 31 32 46.766669 $1169.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1148 1278 1668.588193 $83429.4600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 14 15 16.661111 $416.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1071 1180 1527.750011 $76387.5700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 11 11 17.666669 $441.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1755 1948 2131.525159 $106576.2600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 23 24 28.197620 $704.9400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.066667 $78.2100 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 6 6 718.571429 $8982.1400 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 130 153 1059.859889 $26496.4900 $25.0000
EIIF -90812 INDIVIDUAL PSYCHOTHERAPY, 45-50 MIN 1 1 0.688889 $34.4500 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 2 2 0.888889 $44.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2659 3095 17379.589204 $868979.6900 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 28 30 136.916667 $6845.8400 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 24 25 102.335715 $5116.7900 $50.0000
INTR -INTR INTERPRETER 50 68 329.914710 $16495.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 849 978 4758.348002 $322996.7500 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 8 8 35.973809 $1954.1000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 953 1074 4794.618429 $325458.8900 $67.8800
PHY -97110HM PT SESSION BY PT ASST 16 16 55.454760 $3012.3000 $54.3200
SENS -FM FM RECEIVER HEARING AID 1 1 0.450000 $742.5000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 6 6 1.985540 $992.7500 $499.9900
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 3.600000 $234.0000 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 8 8 6.055556 $1380.6800 $228.0000
SENS -V5264 EARMOLD 32 32 19.985160 $359.7300 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 13 14 41.016667 $2050.8400 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 27 27 104.276985 $5213.8500 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1314 1491 7358.120190 $499469.3300 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.357143 $128.0400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 40.461906 $534.1000 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 336 451 2447.657145 $24476.5800 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 2416 3950 646115.182677 $323057.5900 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 30 34 113.224603 $5661.2300 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 33 34 149.199997 $7460.0200 $50.0000
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Subtotal (Total Children Is Unduplicated) 4605 18491 693316.244056 $2902734.8700 $4.1900
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Total 20775 693990.804482 $2926159.5200 $4.2200
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Number of Children (Unduplicated) With at Least One Authorization 5099