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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 35402 FSPSA's found of which 1062 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 1 0.142857 $5.2900 $37.0100
SCONLY-SCONLY *SERVICE COORDINATION ONLY 4 5 3.011111 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 17 21 70.356350 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 151 158 136.489976 $5050.1400 $37.0000
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Subtotal (Total Children Is Unduplicated) 171 185 210.000294 $5055.4200 $24.0700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 79 88 146.998857 $7129.4300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 17 17 5.818417 $273.9800 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 164 166 41.550001 $620.3400 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 186 201 75.888892 $1457.0700 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 164 165 46.335921 $482.8200 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 7 3.383867 $74.2800 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 173 173 47.042693 $411.6200 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.200000 $1.6100 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 174 176 52.892694 $1155.1800 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.466667 $13.4900 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 96 98 24.762785 $1613.0500 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 163 164 40.322299 $923.3800 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 5.990715 $152.9400 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 22 22 9.085814 $425.2200 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 40 41 9.737670 $1164.6000 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 3 4 0.350685 $43.8300 $124.9700
EVAL -96111 DEVELOPMENTAL EVALUATION 23 37 5.552045 $277.6300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 385 434 600.883553 $30044.1300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.483333 $111.2500 $75.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 0.677778 $37.6200 $55.5000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 41 44 20.965603 $1572.4600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 47 57 182.798707 $13709.9400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 16 16 2.775321 $208.1600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 43 55 43.667185 $3275.0200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 67 76 42.894780 $2380.6700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 670 670 288.142304 $21611.3000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 189 190 122.698591 $9202.5700 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 159 159 39.474706 $2960.7500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 562 566 382.965398 $21254.7600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 305 328 186.749314 $14006.3700 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 1.714286 $85.7200 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 9 12 39.603173 $1980.1600 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 54 55 69.431479 $3544.4700 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 260 265 156.915100 $8010.5300 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 21 25 6.523680 $978.5600 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 83 87 34.585503 $1765.5700 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 163 175 198.293182 $10122.8500 $51.0500
SCREEN-T1023 SCREENING 65 67 41.503045 $2075.1600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 0.424733 $6.6300 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 0.457915 $23.3800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 1.067580 $54.5000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 422 442 437.141103 $22316.0700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 20 21 20.647677 $1054.0800 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.109589 $5.4800 $50.0100
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Subtotal (Total Children Is Unduplicated) 2805 5128 3441.274640 $188633.5800 $54.8200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 106 117 99.671401 $498359.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 14 14 4.703955 $235.1900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 66 66 78.044128 $3902.2100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.150000 $10.7400 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 2.412862 $172.7900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 1.887975 $451.6100 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1055 1253 492.396646 $24620.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 86 98 20.752942 $518.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2115 3815 5438.800192 $271940.0400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 44 76 74.799053 $1869.9700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 84 91 119.537303 $5976.8700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 78 83 111.009447 $5550.4800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 173 183 203.734127 $10186.7100 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 5.228571 $383.3600 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 3 3 71.428571 $1785.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 260 291 2853.614395 $71340.3500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 4 126.285715 $6314.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 14 15 44.138888 $2206.9400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5829 6614 38719.077640 $1935953.4000 $50.0000
INTR -T1013 INTERPRETER 133 161 664.802696 $33240.1700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4389 7056 26961.382791 $269613.7000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 982 1085 5835.180764 $416865.2600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 93 98 468.415084 $26793.3200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1189 1339 6722.012579 $480220.3600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 85 90 359.537304 $20551.1600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 11 11 2.079526 $135.1700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 0.975000 $115.6000 $118.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 19 19 3.905022 $925.9500 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 4 4 0.210958 $100.0600 $474.3300
SENS -V5264 EARMOLD 69 73 42.948716 $773.0800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2118 2386 13489.790414 $963710.5400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 18.857143 $1078.6300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 46 46 303.812701 $4216.9200 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 1688 2509 11015.781613 $5507.8900 $0.5000
TRAV -TRAVS Travel by mile 1508 2466 84599.514212 $37646.7900 $0.4500
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Subtotal (Total Children Is Unduplicated) 9236 30089 198956.880334 $5103273.0900 $25.6500
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Total 35402 202608.155268 $5296962.1000 $26.1400
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Number of Children (Unduplicated) With at Least One Authorization 10140