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 20942 FSPSA's found of which 931 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 3 4 2.633333 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 17 21 70.356350 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 96 101 97.540133 $3608.9800 $37.0000
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Subtotal (Total Children Is Unduplicated) 116 127 170.672673 $3614.2700 $21.1800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 68 76 144.832265 $7024.3500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 3.094444 $145.7200 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 44 44 11.044445 $164.8900 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 55 55 14.772221 $283.6200 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 43 44 10.933334 $113.9300 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 44 44 10.672146 $93.3800 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 45 45 11.111035 $242.6700 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 27 27 6.916667 $450.5500 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 41 41 10.566668 $241.9800 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 0.316286 $8.0800 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 0.930290 $43.5400 $46.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 10 2.364155 $282.7600 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 3 4 0.350685 $43.8300 $124.9700
EVAL -96111 DEVELOPMENTAL EVALUATION 19 31 1.530129 $76.5300 $50.0100
EXIT -EXIT EXIT ASSESSMENT 385 434 600.883553 $30044.1300 $50.0000
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 3 3 0.577321 $43.3000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 13 3.794372 $284.6100 $75.0100
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 2.709458 $203.2100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 7 4.403283 $330.2500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 16 16 1.563701 $86.7900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 78 78 25.196649 $1889.8200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 26 26 12.016237 $901.2400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 12 12 4.340505 $325.5500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 86 86 29.718637 $1649.4200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 21 21 18.225043 $1366.9000 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 1.714286 $85.7200 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 15 15 48.560681 $2479.0200 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 79 80 55.571169 $2836.9200 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 20 24 6.523680 $978.5600 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 23 24 20.499205 $1046.4800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 35 41 22.174886 $1132.0300 $51.0500
SCREEN-T1023 SCREENING 26 27 27.919177 $1395.9600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.172222 $2.6900 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.385693 $19.6900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.033333 $1.7000 $51.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 134 137 109.817001 $5606.1600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 14 15 9.966723 $508.8100 $51.0500
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Subtotal (Total Children Is Unduplicated) 1004 1507 1236.879363 $62472.3500 $50.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 39 41 69.384859 $346925.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 8 8 2.466665 $123.3300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 47 47 64.409511 $3220.4800 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.150000 $10.7400 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 0.935084 $66.9600 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 914 1088 462.126554 $23106.6000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 20 23 4.890431 $122.2600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1956 3467 4855.640980 $242782.0700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 39 69 73.668533 $1841.7000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 78 84 111.966668 $5598.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 72 77 106.207067 $5310.3600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 165 174 202.919049 $10145.9600 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 5.161904 $378.4700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 22 24 250.514286 $6262.8600 $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 9 10 27.316666 $1365.8300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1302 1453 8620.656376 $431032.7600 $50.0000
INTR -T1013 INTERPRETER 133 161 664.802696 $33240.1700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4360 6975 26826.672474 $268266.5900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 234 262 1446.328972 $103325.7400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 18 18 76.535716 $4377.8500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 227 240 1141.832151 $81572.4700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 19 19 84.092857 $4806.7500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 10 1.629526 $105.9200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.088889 $10.5400 $118.5700
SENS -V5264 EARMOLD 15 17 7.079603 $127.4300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 639 691 3966.936005 $283397.8700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 17 17 117.739685 $1634.2300 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 1212 1863 7821.372912 $3910.6800 $0.5000
TRAV -TRAVS Travel by mile 1504 2459 84401.942784 $37558.8800 $0.4500
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Subtotal (Total Children Is Unduplicated) 7177 19308 141541.754618 $1906943.6000 $13.4700
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Total 20942 142949.306654 $1973030.2200 $13.8000
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Number of Children (Unduplicated) With at Least One Authorization 7481