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 46 51 11.844444 $574.4500 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 30 30 6.277775 $81.9200 $13.0500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 30 5.277775 $48.0800 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 30 30 5.277775 $49.2900 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 30 30 5.277775 $114.6800 $21.7300
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 5 5 0.983332 $55.9800 $56.9300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 22 22 3.211109 $78.5700 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 15 16 5.311112 $318.6700 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.700000 $76.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 2.005556 $230.6400 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 4 4 0.213698 $10.6900 $50.0200
EXIT -EXIT EXIT ASSESSMENT 61 61 9.850687 $492.5200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.008333 $0.6200 $74.7000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.022222 $1.6700 $74.9300
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 45 45 0.419853 $31.4700 $74.9500
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 0.016437 $1.2400 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 19 19 0.136524 $7.5900 $55.5700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 0.092692 $6.9500 $75.0100
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 5 6 0.983334 $47.7000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 55 58 14.197183 $688.5500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 4 0.572222 $27.7500 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 38 39 10.172225 $493.3700 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 89 95 26.351161 $1278.0200 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.355556 $35.5600 $100.0100
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Subtotal (Total Children Is Unduplicated) 378 570 110.558780 $4752.4900 $42.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 20 8.031356 $40157.5000 $5000.0900
AUD -HA_FUP AUDIOLOGY SERVICES 12 12 15.340488 $767.0300 $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 1375 1752 2025.751619 $101287.5800 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 31 32 46.766669 $1169.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1147 1277 1666.988193 $83349.4600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 14 15 16.661111 $416.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1069 1178 1523.816677 $76190.9000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 11 11 17.666669 $441.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1753 1946 2129.725159 $106486.2600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 23 24 28.197620 $704.9400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 14 113.002738 $2825.0700 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 0.533333 $26.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 769 901 5233.911891 $261695.6300 $50.0000
INTR -INTR INTERPRETER 50 68 329.914710 $16495.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 140 150 810.176191 $54994.8000 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 2 2 5.035714 $273.5400 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 137 150 664.864089 $45131.0400 $67.8800
PHY -97110HM PT SESSION BY PT ASST 3 3 27.447619 $1490.9500 $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 2 2 1.188889 $594.4500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 3.400000 $221.0000 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 1.377778 $314.1400 $228.0000
SENS -V5264 EARMOLD 8 8 4.200001 $75.6000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 4 4 2.322221 $116.1100 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 321 368 1922.138078 $130474.7700 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 5.357143 $70.7200 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 335 449 2442.257145 $24422.5800 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 2412 3939 644679.611249 $322339.8100 $0.5000
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Subtotal (Total Children Is Unduplicated) 3792 12995 663754.493861 $1274657.2700 $1.9200
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Total 13718 664012.785973 $1279409.7600 $1.9300
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Number of Children (Unduplicated) With at Least One Authorization 4078