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: 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 117 121 136.134918 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 117 121 136.134918 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 54 63 15.017960 $728.3700 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 103 104 26.033324 $339.7300 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 1.022222 $17.1500 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 108 109 26.411102 $240.6000 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 110 110 26.633324 $248.7500 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 108 109 26.444435 $574.6200 $21.7300
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 13 13 2.622221 $149.3000 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 80 81 18.772215 $459.3400 $24.4700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.072222 $1.9700 $27.2700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 92 99 103.000535 $6180.0500 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 14 13.995033 $629.7800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 22 23 17.974094 $2067.0300 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 3 3 0.186301 $9.3200 $50.0300
EXIT -EXIT EXIT ASSESSMENT 58 58 10.629527 $531.4600 $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 191 191 1.558484 $116.9000 $75.0100
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 44 44 0.232035 $17.4400 $75.1500
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 18 20 17.576985 $852.4800 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 354 375 114.364334 $5546.7100 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 16 17 2.913243 $141.3000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 267 282 91.990006 $4461.5400 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 351 371 108.279073 $5251.5500 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 12.857143 $1285.7100 $100.0000
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Subtotal (Total Children Is Unduplicated) 1419 2259 639.898196 $29933.3000 $46.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 38 41 28.844903 $144225.0000 $5000.0200
AUD -HA_FUP AUDIOLOGY SERVICES 26 28 53.070266 $2653.5200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 501 635 30.138322 $1507.4400 $50.0200
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 28 28 0.172058 $4.3100 $25.0600
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1371 1491 2210.567577 $110528.4000 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 24 24 37.833333 $945.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1196 1306 1893.985914 $94699.2600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 10 10 13.305554 $332.6400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1165 1257 1828.659910 $91432.9400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 14 18.666667 $466.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1839 1985 2600.567989 $130028.3500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 12 19.322222 $483.0600 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 6 6 874.142858 $10926.7900 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 77 95 669.457138 $16736.4300 $25.0000
EIIF -90812 INDIVIDUAL PSYCHOTHERAPY, 45-50 MIN 1 1 0.688889 $34.4500 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 0.533333 $26.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2784 3114 19322.749753 $966137.0100 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 7 7 25.150000 $1257.5000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 28 28 117.919049 $5895.9600 $50.0000
INTR -INTR INTERPRETER 41 54 268.057566 $13402.8500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 850 954 5327.376225 $361622.1200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 6 6 32.107143 $1744.0600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 949 1060 5187.468089 $352125.1100 $67.8800
PHY -97110HM PT SESSION BY PT ASST 13 13 64.419048 $3499.2500 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 8 9 2.510656 $1255.4000 $500.0300
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 4 1.205556 $78.3600 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 12 12 5.505558 $1255.3200 $228.0100
SENS -V5264 EARMOLD 39 41 26.115366 $470.0800 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 4 4 19.050000 $952.5000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 36 37 95.028572 $4751.4300 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1342 1503 7953.345697 $539872.7800 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.428571 $186.2400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 77.538097 $1023.5000 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1721 2474 16510.585777 $165105.8100 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 1062 1895 512111.340582 $256055.6700 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 6 6 66.614286 $3330.7200 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 23 25 99.092861 $4954.6400 $50.0000
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Subtotal (Total Children Is Unduplicated) 4701 18192 577596.565385 $3290008.0200 $5.7000
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Total 20572 578372.598499 $3319941.3200 $5.7400
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Number of Children (Unduplicated) With at Least One Authorization 4984