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 14290 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 116 123 133.720640 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 8 24.846826 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 2.688888 $99.4900 $37.0000
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Subtotal (Total Children Is Unduplicated) 132 140 161.834132 $120.8600 $0.7500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 78 89 43.725996 $2120.7400 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 50 50 14.483333 $278.0800 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.744444 $7.7600 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.068493 $1.5000 $21.9500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 1.810959 $46.2300 $25.5300
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_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 3 3 0.433257 $32.5000 $75.0100
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 10 10 5.227777 $392.0800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.888812 $66.6600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 11 11 5.688888 $315.7300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 17 17 12.853423 $964.0200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 10 10 7.747162 $581.0500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 0.021916 $1.6500 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 13.219765 $733.7000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 9 7.389042 $554.1800 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 3 3 3.000000 $153.1500 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 35 37 22.783182 $1163.0900 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 6 6 7.265950 $370.9200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 30 30 25.478592 $1300.6800 $51.0500
SCREEN-T1023 SCREENING 3 3 1.245738 $62.2900 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.087671 $4.4800 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 55 57 80.312797 $4099.9800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 4 4 2.350000 $119.9700 $51.0500
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Subtotal (Total Children Is Unduplicated) 617 738 692.088025 $35350.4200 $51.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 27 12.736455 $63683.0000 $5000.0600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 3.183333 $159.1700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 70 72 117.433103 $5871.6400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 6.071429 $434.7700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.372222 $89.0300 $239.1900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 701 824 756.471279 $37823.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 30 36 32.214248 $805.3500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1817 2675 3475.371678 $173768.7200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 75 104 348.283332 $8707.0800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 370 425 554.050010 $27702.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 13 13 20.538095 $513.4500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 295 318 401.652387 $20082.6500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 1.516667 $37.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 923 988 1057.206434 $52860.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 25 26 69.447641 $1736.1900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 4.416667 $323.8300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 26 29 222.428570 $5560.7200 $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 244 261 1516.392858 $75819.6200 $50.0000
INTR -T1013 INTERPRETER 117 141 558.360088 $27918.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3115 4959 22038.177032 $220381.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 99 106 687.670635 $49127.2100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 10 48.700001 $2785.6300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 107 111 579.062302 $41368.2000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 10 10 40.435714 $2311.3000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 1.365905 $88.7800 $65.0000
SENS -V5060 BEHIND EAR HEARING AID
2 2 0.189041 $44.8200 $237.0700
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 221 247 1416.670637 $101206.9000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.428571 $138.9200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 25.000000 $347.0000 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 3 4 8.892064 $4.4500 $0.5000
TRAV -TRAVS Travel by mile 1263 1985 126722.945195 $56391.7200 $0.4500
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Subtotal (Total Children Is Unduplicated) 5191 13412 160903.758989 $986798.0600 $6.1300
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Total 14290 161757.681146 $1022269.3400 $6.3200
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Number of Children (Unduplicated) With at Least One Authorization 5440