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
Eligibility Filter: Program Patients
With the filters selected there were 39151 FSPSA's found of which 2358 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 26 39 142.876987 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 154 163 687.227386 $25427.4100 $37.0000
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Subtotal (Total Children Is Unduplicated) 183 208 835.415484 $25623.9200 $30.6700
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 0.433333 $44.4700 $102.6200
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 105 127 122.975798 $5964.3200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 3.783333 $178.1600 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 64 64 120.933330 $1805.5300 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 62 64 115.800000 $2223.3600 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 65 66 121.415445 $1265.1500 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 91.000000 $1997.4500 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 67 68 121.331656 $1061.6500 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 91.205556 $735.1200 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 67 67 121.249540 $2648.0800 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 91.087671 $2632.4300 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 40 40 111.198410 $7243.4500 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 62 63 28.625263 $655.5100 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 92.179832 $2353.3500 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 13 70.207468 $3285.7100 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 11.822570 $1413.9800 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 0.301599 $37.7000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 24 33 35.288889 $1764.4400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 443 484 560.845282 $28042.2700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.010959 $0.8300 $75.2800
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 6 6 3.120776 $234.0500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 7 7 6.083257 $456.2500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 17 18 18.660815 $1399.5700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 13 5.661948 $314.2400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 51 53 35.193682 $2639.5700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 18 19 17.693605 $1327.0400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 10 10 4.772601 $357.9500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 94 95 50.285761 $2790.9000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 30 33 34.600261 $2595.0300 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 12.571429 $628.5700 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.100000 $5.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.766667 $38.3400 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 31 35 100.775941 $5144.6200 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 103 107 110.486654 $5640.3200 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 86 95 70.017417 $10502.6700 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 49 57 62.541289 $3192.7300 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 55 57 101.698452 $5191.6900 $51.0500
SCREEN-T1023 SCREENING 38 40 20.060730 $1003.0500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 1.572222 $24.5300 $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 224 244 260.301233 $13288.3900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 21 21 30.812156 $1572.9700 $51.0500
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Subtotal (Total Children Is Unduplicated) 1323 2046 2860.546726 $123756.5100 $43.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 55 60 149.484420 $747425.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 12 11.984126 $599.2100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 85 90 132.358393 $6617.9300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.477778 $34.2200 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 7 7 14.263393 $1021.3900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.554642 $132.6800 $239.2300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1043 1259 635.848590 $31792.5500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 25 35 25.815361 $645.4000 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 2984 6177 11345.611834 $567281.4700 $50.0000
CONIP -CONIP CONSULT, PHONE 93 182 282.087702 $7052.2000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 10.082540 $739.2500 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 9.571429 $239.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 40 43 449.161919 $11229.0600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 5 258.946032 $12947.3000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 11 13 65.027776 $3251.3800 $50.0000
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1 1 0.010959 $0.5500 $50.1900
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2537 3081 24830.734621 $1241538.2100 $50.0000
INTR -T1013 INTERPRETER 194 243 2390.761494 $119538.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7945 13923 76539.632218 $765397.0600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 436 514 4081.630189 $291591.8500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 44 49 282.030954 $16132.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 463 563 3958.721440 $282811.1400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 33 34 238.564284 $13636.3500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 15 15 6.941247 $451.1800 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.244444 $28.9800 $118.5400
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 58.438660 $13856.9800 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.131507 $31.1800 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 3 3 0.369863 $175.4200 $474.2900
SENS -V5264 EARMOLD 24 29 251.933799 $4534.8100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1254 1483 11405.056891 $814777.9600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.428571 $196.1200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 52 52 528.699206 $7338.3400 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 3340 5162 36685.396598 $18342.6700 $0.5000
TRAV -TRAVS Travel by mile 2030 3848 184361.838627 $82041.0400 $0.4500
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Subtotal (Total Children Is Unduplicated) 12640 36897 359015.841507 $5063428.4800 $14.1000
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Total 39151 362711.803717 $5212808.9100 $14.3700
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Number of Children (Unduplicated) With at Least One Authorization 12908