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: 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 32321 FSPSA's found of which 1 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 16 17 7.394445 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 16 18 31.297619 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 79 80 42.580158 $1575.4600 $37.0000
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Subtotal (Total Children Is Unduplicated) 109 116 81.415079 $1580.7500 $19.4200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 120 135 60.487159 $2933.6500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 9 1.470471 $69.2400 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 0.903120 $13.4800 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 138 139 45.103115 $865.9700 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 8 8 2.138128 $22.2800 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 16 17 2.857839 $62.7300 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 12 12 2.529147 $22.1300 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 12 12 2.529147 $55.2400 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.175342 $5.0700 $28.8900
AUDE -92585 AUD EVOKED RESPONSE (COMP) 13 13 5.405555 $352.1100 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 2.500000 $95.9300 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 12 12 2.968036 $67.9700 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 10 1.460578 $37.2900 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 16 16 11.883748 $556.1600 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 31 31 9.206847 $1101.1200 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 5 6 1.292922 $161.6000 $124.9900
EVAL -96111 DEVELOPMENTAL EVALUATION 29 43 6.113535 $305.6900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 428 495 606.576399 $30328.7800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 2.883333 $216.2500 $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 44 46 29.962178 $2247.2000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 40 51 33.748023 $2531.1500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 21 21 5.591911 $419.4000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 50 53 46.188508 $3464.1500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 85 98 66.569974 $3694.6600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 674 675 289.587053 $21719.6600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 189 189 119.883294 $8991.4200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 160 160 39.641373 $2973.2500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 569 573 451.136695 $25038.2600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 308 334 289.534995 $21715.2900 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 18 50.985712 $2549.2900 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 42 42 16.220755 $828.0800 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 263 269 192.652643 $9834.9400 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 3 3 0.389041 $58.3500 $149.9800
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 58 58 25.748914 $1314.4900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 252 262 223.369651 $11403.0400 $51.0500
SCREEN-T1023 SCREENING 96 97 50.597869 $2529.9200 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.353425 $5.5100 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 0.627474 $32.0300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 1.076180 $54.9300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 441 454 400.937191 $20467.8400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 44 44 23.290389 $1188.9700 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 3 3 0.353425 $17.6800 $50.0100
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Subtotal (Total Children Is Unduplicated) 2848 4431 3128.608872 $180439.7800 $57.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 143 157 245.884372 $1229425.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 11 12 5.927778 $296.3900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 115 116 63.603266 $3180.2000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 9 4.593044 $328.9100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 22 22 10.820471 $2588.2600 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1160 1411 536.558783 $26828.1500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 107 123 33.450469 $836.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2563 4523 6495.573667 $324778.7500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 82 133 262.551825 $6563.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 195 209 217.575977 $10878.8100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 124 141 178.241991 $8912.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 398 416 384.491879 $19224.6000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 8.380952 $209.5200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 1.409524 $103.3500 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 1.714286 $42.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 250 266 3145.347600 $78633.7200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 81.142857 $4057.1500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 19 20 84.178681 $4208.9400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5914 6448 37480.941238 $1874048.1900 $50.0000
INTR -T1013 INTERPRETER 103 136 399.487546 $19974.4100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3974 6213 27572.816444 $275728.3000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 946 1018 5563.784269 $397477.1100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 122 131 718.815076 $41116.2600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 998 1098 5694.955498 $406847.8800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 88 95 486.785129 $27824.6500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 9 2.011263 $130.7400 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 15 15 3.842541 $911.1600 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
4 4 0.624657 $148.1100 $237.1000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 3 3 0.407153 $193.1100 $474.2900
SENS -V5264 EARMOLD 51 52 49.608760 $892.9500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2011 2169 12938.222126 $924307.2100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 14.571429 $833.4800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 80 81 705.469048 $9791.9100 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 3 3 3.077778 $1.5400 $0.5000
TRAV -TRAVS Travel by mile 1508 2721 128080.890233 $56996.0100 $0.4500
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Subtotal (Total Children Is Unduplicated) 8895 27774 231477.757610 $5758320.2700 $24.8800
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Total 32321 234687.781561 $5940340.8100 $25.3100
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Number of Children (Unduplicated) With at Least One Authorization 9419