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: 07-01-16 and 09-30-16 Date of Report: 10-26-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 25522 FSPSA's found
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 0.577778 $21.3800 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 119 126 135.516671 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 8 24.846826 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 30 30 31.711110 $1173.3100 $37.0000
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Subtotal (Total Children Is Unduplicated) 157 165 192.652385 $1194.6900 $6.2000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 87 98 46.329040 $2246.9900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 1.444443 $68.0100 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.450000 $6.7200 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 210 213 61.127779 $1173.6600 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 3.000000 $31.2600 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 17 17 5.669329 $124.4400 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 6 2.502131 $21.8900 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 2.502131 $54.6500 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 8 8 3.155556 $205.5600 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 0.502131 $11.5000 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 1.810959 $46.2300 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 15 15 12.257055 $573.6300 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 22 23 10.627549 $1271.0500 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 2.866667 $358.3400 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 30 37 30.551201 $1527.5800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 308 334 400.487404 $20024.3500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 2.533333 $190.0000 $75.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 0.355556 $19.7400 $55.5100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 40 42 45.736123 $3430.2100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 31 41 33.162551 $2487.1800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 8.937899 $670.3400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 36 38 37.094900 $2782.1100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 65 78 63.843237 $3543.2800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 491 493 467.068011 $35030.4500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 188 188 135.762972 $10182.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 122 122 106.858877 $8014.5100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 450 453 543.596550 $30169.6700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 184 196 258.908016 $19418.1200 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 9 9 32.395237 $1619.7600 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 28 29 21.754750 $1110.5700 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 218 223 156.800342 $8004.6700 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 32 34 17.817833 $909.6000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 175 180 219.411544 $11200.9700 $51.0500
SCREEN-T1023 SCREENING 38 39 20.410656 $1020.5400 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 5.000000 $255.2500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 2.776561 $141.7500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 275 288 220.586302 $11260.9200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 34 35 17.711081 $904.1600 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.106849 $5.3400 $49.9800
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Subtotal (Total Children Is Unduplicated) 2157 3293 3004.912555 $180167.3600 $59.9600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 97 108 195.301219 $976510.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 7 4.883334 $244.1700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 81 84 128.949769 $6447.4700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 7.876985 $564.0700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 1.773211 $424.1300 $239.1900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 809 960 840.701558 $42035.1600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 59 66 42.471938 $1061.7900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1882 2756 3578.064532 $178903.3800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 76 105 348.683332 $8717.0800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 400 456 612.972231 $30648.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 13 13 20.538095 $513.4500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 322 346 452.214291 $22610.7500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 1.516667 $37.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 964 1031 1125.953258 $56297.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 25 26 69.447641 $1736.1900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 12 13 32.583334 $2389.0100 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 2 36.000000 $900.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 242 287 1869.823777 $46745.6100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 98.285714 $4914.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 14 17 75.789682 $3789.4900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4901 5496 32906.243212 $1645311.7500 $50.0000
INTR -T1013 INTERPRETER 119 143 562.104380 $28105.2200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3118 4965 22076.848461 $220768.4000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 670 738 4158.219073 $297063.1600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 91 98 520.723812 $29785.4000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 761 828 4284.022308 $306050.4500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 61 62 295.954154 $16916.7200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 7 1.827016 $118.7600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 12 12 5.817047 $1379.3300 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
3 3 0.224657 $53.2600 $237.0600
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 3 3 1.116742 $529.5800 $474.2200
SENS -V5264 EARMOLD 30 31 29.587520 $532.5800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1213 1356 7870.206037 $562247.4900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 19.142857 $1094.9700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 27 27 137.826985 $1913.0400 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 3 4 8.892064 $4.4500 $0.5000
TRAV -TRAVS Travel by mile 1266 1992 126798.230910 $56425.2200 $0.4500
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Subtotal (Total Children Is Unduplicated) 6994 22064 209220.817803 $4553790.0300 $21.7700
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Total 25522 212418.382743 $4735152.0800 $22.2900
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Number of Children (Unduplicated) With at Least One Authorization 7698