Summary Report for FSPSAs Initiated During the Report Period Statewide
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting between: 10-01-15 and 12-31-15 Date of Report: 02-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 46580 FSPSA's found of which 1928 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 1 3 3.000000 $111.0000 $37.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 21 30 123.632542 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 220 236 1378.695111 $51011.7000 $37.0000
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Subtotal (Total Children Is Unduplicated) 240 269 1505.327653 $51122.7000 $33.9600
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 79 98 109.130136 $5292.8100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 15 17 6.980973 $328.7300 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 215 216 187.052049 $2792.6800 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 191 194 185.320311 $3558.1500 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 217 219 189.197940 $1971.4400 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 10 11 96.052362 $2108.3500 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 228 230 191.627545 $1676.7400 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 5 5 92.250000 $743.5400 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 229 233 191.643069 $4185.4800 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 91.000000 $2629.9000 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 114 115 140.016286 $9120.6600 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.511111 $19.6100 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 220 220 94.159204 $2156.2400 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 8 94.772831 $2419.5500 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 21 24 25.085040 $1173.9800 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 36 44 36.130986 $4321.3000 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 18 25 30.328463 $1516.4300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 318 347 435.667716 $21783.3800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 1.299848 $97.4900 $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 28 32 22.796569 $1709.7400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 48 53 394.159456 $29561.9600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 4.897032 $367.2800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 48 78 105.644610 $7923.3000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 58 61 51.197381 $2841.4500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 353 358 163.638555 $12273.2600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 141 142 76.107803 $5708.2100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 82 83 32.623269 $2446.8100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 318 323 343.859835 $19084.3000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 184 204 126.847721 $9513.6800 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 12.571429 $628.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 6 48.236508 $2411.8300 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 64 72 35.934209 $1834.4200 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 273 289 163.853268 $8364.7200 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 63 68 63.959338 $9593.9600 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 93 104 49.587136 $2531.4200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 192 195 317.257227 $16195.9900 $51.0500
SCREEN-T1023 SCREENING 48 50 22.948555 $1147.4300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.153729 $18.0000 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.200000 $10.2100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.590563 $30.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 389 414 435.113342 $22212.5500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 9 9 89.940846 $4591.4800 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.504110 $25.2100 $50.0100
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Subtotal (Total Children Is Unduplicated) 2337 4571 4764.137173 $229143.9200 $48.1000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 88 104 81.455068 $407278.0000 $5000.0300
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 7 19.953968 $997.7000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 71 74 94.696019 $4734.8000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 11.472222 $821.5200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 0.568797 $136.0600 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 828 1016 483.047803 $24152.3800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 43 49 15.588158 $389.7000 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 2272 4599 8159.015355 $407951.2600 $50.0000
CONIP -CONIP CONSULT, PHONE 77 144 215.430763 $5385.7800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 3.511111 $257.4300 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 3 3 78.142858 $1953.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 306 355 4255.109965 $106377.8300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 10 11 64.909523 $3245.4800 $50.0000
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 2 2 2.202740 $110.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8553 10881 84588.153543 $4229412.7600 $50.0000
INTR -T1013 INTERPRETER 178 224 2308.548735 $115427.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5864 10292 56634.346431 $566343.9600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1107 1394 9964.324132 $711851.7200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 103 117 759.205555 $43426.5600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1423 1828 12394.370784 $885454.1500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 111 126 681.275001 $38941.6800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 10 6.415220 $416.9900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.227549 $145.5300 $118.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 18 18 9.504187 $2253.7100 $237.1300
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.131507 $31.1800 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 3 3 0.210959 $100.0600 $474.3300
SENS -V5264 EARMOLD 58 70 161.668536 $2910.0300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2215 2752 20338.704092 $1452998.2900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 34.000000 $1944.8100 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 56 59 491.519047 $6822.2900 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 3207 4796 35430.225233 $17715.0700 $0.5000
TRAV -TRAVS Travel by mile 1498 2786 134605.696863 $59899.5500 $0.4500
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Subtotal (Total Children Is Unduplicated) 11254 41740 371894.631724 $9099887.4700 $24.4700
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Total 46580 378164.096550 $9380154.0900 $24.8000
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Number of Children (Unduplicated) With at Least One Authorization 11619