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: 10-01-13 and 12-31-13 Date of Report: 02-18-14 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 87 89 65.799205 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 87 89 65.799205 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 40 44 10.339345 $501.4600 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.555556 $22.3400 $14.3600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 6 6 2.538889 $46.8700 $18.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 2.538889 $25.4400 $10.0200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 7 3.516667 $29.5800 $8.4100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.688889 $5.3400 $7.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 7 3.516667 $73.8500 $21.0000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 13 13 4.438890 $278.0100 $62.6300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 1.977777 $43.5500 $22.0200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.433333 $10.6400 $24.5500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 66 69 180.108377 $10806.5300 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 11 11.841160 $532.8500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 21 21 18.474787 $2124.5800 $115.0000
EXIT -EXIT EXIT ASSESSMENT 23 23 3.760884 $188.0400 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 8 8 2.581747 $125.2200 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 312 332 114.513492 $5553.9000 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 9 9 2.527777 $122.5900 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 234 240 95.486958 $4631.1400 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 347 366 151.787320 $7361.7100 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.142857 $14.2900 $100.0300
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Subtotal (Total Children Is Unduplicated) 914 1171 612.770261 $32497.9300 $53.0300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 27 30 33.488052 $167440.5000 $5000.0100
AUD -HA_FUP AUDIOLOGY SERVICES 22 23 72.463678 $3623.1800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 137 169 122.007589 $6100.4100 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 2 2 1.444444 $36.1100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1891 2584 3431.281518 $171563.1100 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 20 20 29.066670 $726.6800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1752 2430 3277.981935 $163898.1600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 6.355555 $158.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1738 2402 3231.581534 $161578.0400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 13 13 21.966670 $549.1800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2375 3102 3807.556165 $190376.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 10.266668 $256.6700 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 5 5 861.142858 $10764.2900 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 127 140 1008.004745 $25200.1600 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 1.466667 $73.3400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 1.466667 $73.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2667 2999 17519.057030 $875953.1800 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 13 13 64.933333 $3246.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 23 23 128.845237 $6442.2800 $50.0000
INTR -INTR INTERPRETER 17 17 149.887301 $7494.3600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 827 909 4758.729730 $323022.7500 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 10 10 52.188096 $2834.8600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 945 1024 4899.303945 $332564.9800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 13 13 64.428572 $3499.7600 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 1.299391 $649.6500 $499.9600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 1.744445 $113.3900 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 9 9 5.077778 $1157.7400 $228.0000
SENS -V5264 EARMOLD 34 36 32.827962 $590.9000 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 0.300000 $15.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 46 47 83.044443 $4152.2300 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1412 1537 8040.819025 $545810.9200 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 30.428572 $1652.8800 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 13 14 57.965872 $765.1500 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1757 2637 15133.270586 $151332.7300 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 807 1361 358036.214115 $179018.1100 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 14 15 61.027579 $3051.3800 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 15 16 60.050794 $3002.5400 $50.0000
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Subtotal (Total Children Is Unduplicated) 5014 21630 425098.985221 $3348790.3600 $7.8800
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Total 22890 425777.554687 $3381288.2900 $7.9400
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Number of Children (Unduplicated) With at Least One Authorization 5155