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 35 39 9.366667 $454.2900 $48.5000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 4 4 1.083334 $67.8500 $62.6300
AUDE -AUDE UNSPECIFIED AUDE SERVICES 13 14 9.155557 $549.3400 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.866667 $39.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 6.222222 $715.5500 $115.0000
EXIT -EXIT EXIT ASSESSMENT 21 21 3.563624 $178.1800 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 62 63 28.991270 $1406.0800 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.211111 $10.2400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 32 32 8.788889 $426.2600 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 104 110 61.531750 $2984.3000 $48.5000
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Subtotal (Total Children Is Unduplicated) 232 289 129.781091 $6831.0900 $52.6400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 11 2.721386 $13607.5000 $5000.2100
AUD -HA_FUP AUDIOLOGY SERVICES 12 13 63.979367 $3198.9700 $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 1884 2294 3173.337072 $158665.8800 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 20 20 29.066670 $726.6800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1743 2141 3006.753362 $150336.7200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 6.355555 $158.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1729 2118 2967.864071 $148392.1500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 13 13 21.966670 $549.1800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2367 2810 3538.660925 $176932.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 10.266668 $256.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 7 138.647619 $3466.1900 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 1.466667 $73.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 789 887 5197.314265 $259865.7600 $50.0000
INTR -INTR INTERPRETER 17 17 149.887301 $7494.3600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 149 158 777.333333 $52765.4100 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 2 2 4.642857 $252.2000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 157 167 768.393641 $52158.5600 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 0.966667 $483.3500 $500.0200
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 1.744445 $113.3900 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 1.233334 $281.2200 $228.0100
SENS -V5264 EARMOLD 7 7 5.961112 $107.3000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 11 11 7.799999 $390.0000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 342 365 1921.138881 $130406.9100 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.714286 $473.3600 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 15.789682 $208.4200 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1755 2635 15125.127729 $151251.3000 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 790 1318 354711.299829 $177355.6500 $0.5000
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Subtotal (Total Children Is Unduplicated) 4269 15193 391781.885426 $1496107.9600 $3.8200
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Total 15571 391977.465722 $1502939.0600 $3.8300
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Number of Children (Unduplicated) With at Least One Authorization 4394