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
Eligibility Filter: Program Patients
With the filters selected there were 35910 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 156 163 180.480959 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 11 12 37.167462 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 33 33 32.905554 $1217.5000 $37.0000
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Subtotal (Total Children Is Unduplicated) 200 209 251.131753 $1238.8800 $4.9300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 120 135 58.056589 $2815.7800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 2.176025 $102.4600 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 2.019515 $30.1500 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 299 303 89.367464 $1715.8600 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 9 9 7.763959 $80.9000 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 26 26 7.894290 $173.2800 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 13 13 7.471569 $65.3800 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.928571 $7.4800 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 13 13 7.279940 $159.0000 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.928571 $26.8400 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 15 15 7.744444 $504.4700 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 4.071429 $156.2200 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 7 7 1.324886 $30.3400 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 9 5.962437 $152.2200 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 26 26 17.397389 $814.1900 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 35 36 15.459664 $1848.9800 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 3.088889 $386.1100 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 34 42 32.747547 $1637.4000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 420 459 579.147255 $28957.3400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 2.633333 $197.5000 $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 54 56 65.551190 $4916.3300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 33 43 35.345884 $2650.9300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 11.348934 $851.1800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 51 54 60.253042 $4518.9700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 73 86 70.085550 $3889.7200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 675 678 659.117119 $49434.2600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 257 257 174.064323 $13055.0900 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 161 161 137.982309 $10348.7900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 595 598 718.969747 $39902.9100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 265 282 371.041041 $27828.0900 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 16 16 58.709521 $2935.4700 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 45 46 33.926439 $1731.9400 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 374 383 260.435397 $13295.2500 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 52 54 24.559996 $1253.7900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 281 293 303.602881 $15498.9600 $51.0500
SCREEN-T1023 SCREENING 48 49 27.257340 $1362.8700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.984779 $15.3600 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 5.050000 $257.8000 $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 510 535 381.797298 $19490.7700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 43 44 20.039772 $1023.0400 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.210959 $10.5500 $49.9900
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Subtotal (Total Children Is Unduplicated) 3163 4782 4277.929404 $254345.4500 $59.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 147 170 211.761339 $1058810.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 11 6.016667 $300.8400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 113 116 145.832070 $7291.5900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 7 7 8.648751 $619.3400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 24 24 8.520622 $2038.0800 $239.1900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1138 1354 1139.591221 $56979.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 86 94 58.445392 $1461.1300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2524 3741 5237.217456 $261861.1300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 98 135 408.011106 $10200.2600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 594 671 926.716675 $46335.9200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 20 21 43.311111 $1082.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 451 489 666.775402 $33338.8200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 5 5 3.700000 $92.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1347 1447 1689.681379 $84484.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 34 36 103.580181 $2589.5100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 12 13 32.583334 $2389.0100 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 3 46.000000 $1150.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 330 400 2632.880917 $65822.0600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 7 270.571429 $13528.5700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 17 20 88.134126 $4406.7100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6487 7305 43931.335490 $2196566.2300 $50.0000
INTR -T1013 INTERPRETER 130 155 632.824145 $31641.2100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4123 6666 29847.505066 $298474.9500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1131 1265 6985.278509 $499028.2200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 122 131 686.414290 $39262.8900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1189 1308 6693.271142 $478167.1300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 90 95 473.111297 $27043.0100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 9 1.951293 $126.8300 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 20 20 9.578005 $2271.1400 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
4 4 0.301369 $71.4400 $237.0700
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 6 6 3.561186 $1688.8200 $474.2300
SENS -V5264 EARMOLD 52 53 42.141324 $758.5400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2198 2460 14171.761622 $1012430.4900 $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 45 45 285.684129 $3965.3000 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 3 4 8.892064 $4.4500 $0.5000
TRAV -TRAVS Travel by mile 1640 2624 162046.133006 $72110.5400 $0.4500
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Subtotal (Total Children Is Unduplicated) 9785 30919 279566.865972 $6319488.6500 $22.6000
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Total 35910 284095.927129 $6575072.9700 $23.1400
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Number of Children (Unduplicated) With at Least One Authorization 10780