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 19 21 4.186301 $203.0400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.411111 $18.6100 $45.2800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 2.700001 $38.7700 $14.3600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 2.700001 $49.8400 $18.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 2.700001 $27.0600 $10.0200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 2.700001 $22.7100 $8.4100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 4 4 2.700001 $20.9300 $7.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 2.700001 $56.7000 $21.0000
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 15 15 5.722225 $358.4000 $62.6300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 2.855557 $62.8800 $22.0200
AUDE -AUDE UNSPECIFIED AUDE SERVICES 17 18 36.088891 $2165.3500 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.233334 $10.5000 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 7.646826 $879.3900 $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 2 2 0.338889 $16.4400 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 48 50 13.038892 $632.4000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 36 38 12.284126 $595.7800 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 108 118 32.277777 $1565.4700 $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) 214 310 136.284173 $7037.7100 $51.6400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 1.007915 $5039.5000 $4999.9300
AUD -HA_FUP AUDIOLOGY SERVICES 6 6 1.455556 $72.7800 $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 270 279 319.494449 $15974.7500 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 4 4 1.766666 $44.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 252 273 316.561110 $15828.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.266666 $31.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 262 279 346.435711 $17321.7700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.433333 $10.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 667 718 672.608732 $33630.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.066667 $1.6700 $25.0100
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 5.723810 $143.1000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 519 592 3339.473794 $166973.6900 $50.0000
INTR -INTR INTERPRETER 4 4 13.044444 $652.2200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 91 101 471.974601 $32037.6200 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 94 102 384.711110 $26114.2000 $67.8800
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 3 3 0.291172 $18.9300 $65.0100
SENS -V5264 EARMOLD 8 8 2.883335 $51.9000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 10 13 4.831747 $241.5900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 219 241 1071.080158 $72704.9700 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 9.857143 $535.4400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 17.542857 $231.5700 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.571429 $57.1400 $99.9900
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1535 2375 12605.143621 $126051.4500 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 317 609 104198.699997 $52099.3500 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 1 1 5.100000 $255.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 2229 5629 123793.047751 $566477.4000 $4.5800
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Total 6000 123959.320813 $573515.1100 $4.6300
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Number of Children (Unduplicated) With at Least One Authorization 2329