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 46 53 12.766666 $619.1800 $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 0.755556 $43.0200 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 22 22 3.211109 $78.5700 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 14 14 5.216666 $313.0000 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.300000 $13.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 1.650000 $189.7500 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 3 3 0.186301 $9.3200 $50.0300
EXIT -EXIT EXIT ASSESSMENT 57 57 10.473363 $523.6500 $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 7 8 3.682541 $178.6100 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 52 56 18.473952 $896.0000 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 4 0.672222 $32.6000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 33 35 8.827777 $428.1400 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 100 106 42.726560 $2072.2400 $48.5000
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Subtotal (Total Children Is Unduplicated) 384 570 131.749874 $5741.0900 $43.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 16 16 10.338356 $51692.0000 $5000.0200
AUD -HA_FUP AUDIOLOGY SERVICES 15 17 47.620647 $2381.0400 $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 1164 1255 1827.026576 $91351.2700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 14 18.666667 $466.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1838 1984 2600.334656 $130016.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 12 19.322222 $483.0600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 9 9 69.714286 $1742.8600 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 0.533333 $26.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 822 934 5924.540135 $296226.7300 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 0.833333 $41.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 5.714286 $285.7200 $50.0000
INTR -INTR INTERPRETER 41 54 268.057566 $13402.8500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 148 156 884.203970 $60019.7300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 3 3 15.607143 $847.7800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 149 162 825.834726 $56057.6400 $67.8800
PHY -97110HM PT SESSION BY PT ASST 1 1 11.733333 $637.3500 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 3 3 0.569103 $284.6000 $500.0900
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 1.005556 $65.3600 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 3 0.311111 $70.9300 $227.9900
SENS -V5264 EARMOLD 10 10 3.950002 $71.1000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 9 9 4.800001 $240.0100 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 352 387 2144.759144 $145586.1900 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 17.866667 $235.8400 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1718 2469 16437.900063 $164378.9500 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 1060 1888 510393.340581 $255196.6700 $0.5000
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Subtotal (Total Children Is Unduplicated) 3960 12887 545720.586221 $1479827.2100 $2.7100
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Total 13578 545988.471013 $1485568.2900 $2.7200
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Number of Children (Unduplicated) With at Least One Authorization 4171