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: 01-01-14 and 03-31-14 Date of Report: 06-03-14 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 59 61 29.988889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 59 61 29.988889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 25 28 5.302968 $257.2000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.411111 $18.6100 $45.2800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 19 19 12.755557 $183.1700 $14.3600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 22 23 13.550001 $250.1300 $18.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 24 25 14.172223 $142.0100 $10.0200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 23 24 13.416667 $112.8300 $8.4100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 17 17 11.477779 $88.9500 $7.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 23 24 13.261112 $278.4900 $21.0000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 37 37 25.278575 $1583.2200 $62.6300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 22 22 13.105557 $288.5900 $22.0200
AUDE -AUDE UNSPECIFIED AUDE SERVICES 62 65 93.855558 $5631.3500 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 9 2.907839 $130.8600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 16 17 23.592065 $2713.1100 $115.0000
EXIT -EXIT EXIT ASSESSMENT 6 6 0.805794 $40.2900 $50.0000
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 1 1 1.900000 $57.0000 $30.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.011111 $0.8300 $74.9300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.011111 $0.8300 $74.9300
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.083333 $6.2500 $74.9700
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.083333 $4.6200 $55.4800
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 5 5 0.400001 $19.4100 $48.5100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 281 324 72.874611 $3534.4600 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.044445 $2.1600 $48.5600
PSTH -97001 EVAL BY LICENSED PT, INITIAL 233 280 69.295866 $3360.9000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 320 352 81.677778 $3961.3700 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 1.966667 $196.6700 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.138889 $6.9500 $50.0000
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Subtotal (Total Children Is Unduplicated) 811 1287 472.379951 $22870.2600 $48.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 10 5.085692 $25428.0000 $4999.9100
AUD -HA_FUP AUDIOLOGY SERVICES 14 16 5.053175 $252.6600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 0.349505 $17.4800 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 876 998 2236.387289 $111819.2900 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 4 4 1.766666 $44.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 870 1000 2256.767446 $112838.3000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.266666 $31.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 867 991 2251.726176 $112586.2300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.433333 $10.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1274 1440 2588.762690 $129438.0900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.066667 $1.6700 $25.0100
ECE -ECE EARLY CHILDHOOD EDUCATION 3 3 52.142857 $651.7900 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 133 153 858.152379 $21453.8200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2027 2413 12419.267416 $620963.6100 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 17 18 101.208333 $5060.4200 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 6 6 17.480953 $874.0500 $50.0000
INTR -INTR INTERPRETER 4 4 13.044444 $652.2200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 636 748 3313.284505 $224905.9400 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 8 8 40.142857 $2180.5600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 760 841 3558.083308 $241522.8300 $67.8800
PHY -97110HM PT SESSION BY PT ASST 13 13 43.573016 $2366.8900 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 3 3 0.672223 $336.1500 $500.0600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 0.635616 $41.3100 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 5 6 3.060122 $697.7300 $228.0100
SENS -V5264 EARMOLD 27 28 13.644445 $245.6000 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 4.300000 $215.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 35 45 46.370636 $2318.5300 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 976 1101 4861.232124 $329980.6600 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 10.571429 $574.2400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 26.328572 $347.5400 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.571429 $57.1400 $99.9900
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1536 2378 12624.286477 $126242.8800 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 634 1894 372046.687298 $186023.3400 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 14 14 47.041667 $2352.0900 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 12 13 19.296032 $964.8000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3357 14173 419468.743443 $2263497.5000 $5.4000
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Total 15521 419971.112283 $2286367.7500 $5.4400
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Number of Children (Unduplicated) With at Least One Authorization 3476