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 19286 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 34 34 21.827778 $807.6300 $37.0000
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Subtotal (Total Children Is Unduplicated) 66 70 60.662699 $812.9200 $13.4000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 103 116 44.529169 $2159.6900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.144444 $6.8000 $47.0800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.175342 $2.6200 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 35 35 12.236451 $234.9400 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.397565 $14.5600 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 0.364383 $8.0000 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.142009 $9.9900 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 1.142009 $24.9400 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.175342 $5.0700 $28.8900
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 5 2.366667 $154.1700 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 2.500000 $95.9300 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 1.614231 $36.9700 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 8 1.210578 $30.9100 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.230137 $10.7700 $46.7900
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 0.603043 $72.1100 $119.5700
BEHV -BEHV BEHAVIORAL ASSESSMENT 5 6 1.292922 $161.6000 $124.9900
EVAL -96111 DEVELOPMENTAL EVALUATION 23 35 1.702578 $85.1400 $50.0100
EXIT -EXIT EXIT ASSESSMENT 427 494 606.554481 $30327.6800 $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 4 4 4.810654 $360.8000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 11 11 3.316593 $248.7700 $75.0100
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 2.942791 $220.7000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 3.691552 $276.8600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 15 15 2.474128 $137.3200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 80 80 25.808521 $1935.7100 $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 13 13 4.507172 $338.0500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 91 91 34.273888 $1902.2300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 21 22 10.372596 $777.9600 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 7 7 2.876332 $146.8400 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 55 56 51.643018 $2636.3700 $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 10 10 13.053173 $666.3600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 61 63 52.387467 $2674.3900 $51.0500
SCREEN-T1023 SCREENING 43 44 33.789497 $1689.4800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.123288 $1.9200 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.355556 $18.1500 $51.0600
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.650000 $33.1800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 137 139 125.879570 $6426.1500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 10 10 15.599207 $796.3400 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.208220 $10.4200 $50.0200
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Subtotal (Total Children Is Unduplicated) 1050 1337 1082.227630 $55787.0600 $51.5500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 57 60 39.765878 $198831.5000 $5000.0500
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 5 1.438889 $71.9500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 82 83 39.848633 $1992.4600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.899207 $64.3900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 12 12 7.978843 $1908.5300 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1004 1230 502.325462 $25116.5400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 38 45 29.055462 $726.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2404 4191 6049.794920 $302489.7700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 74 122 254.318131 $6357.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 172 184 195.949787 $9797.5100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 101 116 153.159451 $7657.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 365 383 346.672830 $17333.6500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 6.666666 $166.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 29 30 484.847618 $12121.2000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 66.571428 $3328.5800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 15 16 72.997620 $3649.8900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1168 1257 7475.134859 $373756.9000 $50.0000
INTR -T1013 INTERPRETER 103 136 399.487546 $19974.4100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3966 6194 27470.037873 $274700.5100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 208 229 1422.758225 $101641.9800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 16 16 99.028572 $5664.4400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 188 200 1060.171899 $75738.7000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 21 23 161.271428 $9218.2800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 1.123287 $73.0100 $65.0000
SENS -V5060 BEHIND EAR HEARING AID
3 3 0.408219 $96.7900 $237.1100
SENS -V5264 EARMOLD 6 7 9.611110 $173.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 548 581 3582.239664 $255915.3000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.000000 $228.8000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 28 28 354.107144 $4915.0000 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 3 3 3.077778 $1.5400 $0.5000
TRAV -TRAVS Travel by mile 1502 2707 127627.318803 $56794.1700 $0.4500
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Subtotal (Total Children Is Unduplicated) 6577 17879 177922.067232 $1770507.7500 $9.9500
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Total 19286 179064.957561 $1827107.7200 $10.2000
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Number of Children (Unduplicated) With at Least One Authorization 6846