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: 10-01-15 and 12-31-15 Date of Report: 02-12-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 30090 FSPSA's found of which 1535 had no frequency modifier field, FORCE FREQ MODIFIER to 0
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
CASE -CASE NON-TCM CASE MANAGEMENT 3 6 5.311111 $196.5100 $37.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 11 14 43.951588 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 116 117 767.020507 $28379.7600 $37.0000
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Subtotal (Total Children Is Unduplicated) 128 137 816.283206 $28576.2700 $35.0100
Screening, Eval, and Assessment, Class # 02
AACIO -92597GO AAC INITIAL EVAL BY LICENSED OT 1 1 0.005479 $0.5600 $103.0300
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 2.000000 $205.2600 $102.6300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 41 42 115.276004 $5590.8800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 1.105556 $52.0600 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 113 113 126.829838 $1893.5800 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 73 73 112.324284 $2156.6400 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 117 118 130.473064 $1359.5400 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 6 91.682040 $2012.4200 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 122 123 134.750386 $1179.0700 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 4 4 91.738889 $739.4200 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 123 126 132.644906 $2896.9800 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 91.121004 $2633.4000 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 58 58 111.451539 $7260.0000 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 116 117 36.433871 $834.3500 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 9 97.872221 $2498.6700 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 15 16 67.407002 $3154.6500 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 31 34 19.803087 $2368.4700 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 0.361872 $45.2400 $125.0100
EVAL -96111 DEVELOPMENTAL EVALUATION 19 27 28.992998 $1449.6500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 346 382 484.780784 $24239.0400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 0.980366 $73.5300 $75.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 0.283333 $15.7200 $55.4900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 33 34 86.144820 $6460.8700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 26 28 52.942028 $3970.6600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 8.517809 $638.8400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 41 56 79.816793 $5986.2800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 38 40 37.507277 $2081.6500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 486 490 199.840658 $14988.5400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 187 189 109.329640 $8199.9100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 110 112 41.972579 $3148.0300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 429 436 315.876286 $17531.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 243 269 165.230706 $12392.4400 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 2.533333 $126.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 26.957144 $1347.8600 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 45 46 33.118577 $1690.6900 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 173 176 119.398302 $6095.3000 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 68 73 42.189237 $6328.4600 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 80 81 29.444233 $1503.1300 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 117 118 121.218891 $6188.2100 $51.0500
SCREEN-T1023 SCREENING 40 41 18.578920 $928.9500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.427778 $6.6700 $15.6000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 336 348 264.213872 $13488.1400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 6 6 62.868949 $3209.4600 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.191781 $9.5900 $50.0000
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Subtotal (Total Children Is Unduplicated) 2147 3821 3696.638136 $178980.7000 $48.4200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 50 53 23.418351 $117092.5000 $5000.0300
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 14.653175 $732.6600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 24 25 32.125286 $1606.2600 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 3.552381 $254.3900 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 0.072222 $5.1700 $71.5900
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.488889 $116.9400 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 907 1061 298.922760 $14946.2700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 38 43 2.219708 $55.4900 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 1215 2067 2888.744259 $144437.2400 $50.0000
CONIP -CONIP CONSULT, PHONE 45 77 86.605368 $2165.1400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.444444 $32.5800 $73.3100
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 32.000000 $800.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 197 213 2127.695545 $53192.3800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 4 36.946032 $1847.3000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 6 29.349206 $1467.4600 $50.0000
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 3 3 2.213699 $110.6900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5431 6008 35460.800888 $1773040.0500 $50.0000
INTR -T1013 INTERPRETER 132 159 1160.257669 $58012.9000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3966 6062 23911.172210 $239111.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 865 939 5111.925792 $365196.0700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 65 67 327.151191 $18713.0300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1063 1150 5942.084959 $424502.4300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 61 61 295.546827 $16893.4400 $57.1600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.344444 $40.8300 $118.5400
SENS -V5050 IN EAR MONAURAL HEARING AID 13 13 74.744629 $17723.4900 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 0.323288 $153.3200 $474.2600
SENS -V5264 EARMOLD 58 59 264.366200 $4758.5900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2012 2192 12734.460285 $909750.0600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 10.142857 $580.1700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 36 36 391.214289 $5430.0600 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 2544 3875 20141.233281 $10070.6000 $0.5000
TRAV -TRAVS Travel by mile 1255 1940 48837.086262 $21732.5100 $0.4500
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Subtotal (Total Children Is Unduplicated) 8598 26132 160242.306396 $4204571.6800 $26.2400
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Total 30090 164755.227738 $4412128.6500 $26.7800
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Number of Children (Unduplicated) With at Least One Authorization 9344