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 21715 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 149 156 175.407150 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 11 12 37.167462 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 9 9 2.783332 $102.9800 $37.0000
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Subtotal (Total Children Is Unduplicated) 169 178 215.935722 $124.3600 $0.5800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 101 115 52.818158 $2561.7200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.211111 $9.9400 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.252055 $3.7600 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 78 78 22.822224 $438.1900 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 0.996499 $10.3800 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.290411 $6.3700 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.252055 $2.2100 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.252055 $5.5100 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 2.222222 $144.7500 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 4.071429 $156.2200 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.252055 $5.7700 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 2.300533 $58.7300 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 2.422222 $113.3600 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 2.643379 $316.1500 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 3.088889 $386.1100 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 33 41 31.747547 $1587.4000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 420 459 579.147255 $28957.3400 $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 8 8 5.738735 $430.4000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 11 11 7.227777 $542.0800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.405556 $180.4200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 9 8.138735 $610.4000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 14 14 8.099923 $449.5400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 79 79 82.276960 $6170.8400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 29 29 20.318390 $1523.9100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 7 7 1.532874 $114.9800 $75.0100
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 86 86 85.997077 $4772.8500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 47 49 42.997409 $3224.8100 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 10 10 13.122222 $669.8900 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 124 128 97.490111 $4976.9000 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 14 14 10.149284 $518.1200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 82 84 66.566774 $3398.2400 $51.0500
SCREEN-T1023 SCREENING 6 6 1.991629 $99.5800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.984779 $15.3600 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.050000 $2.5500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.087671 $4.4800 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 177 186 160.614845 $8199.4200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 8 8 3.728386 $190.3300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.104110 $5.2100 $50.0000
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Subtotal (Total Children Is Unduplicated) 1163 1462 1326.768902 $70933.9600 $53.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 53 65 22.906699 $114534.5000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 3.394444 $169.7200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 81 83 124.283103 $6214.1400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 6.221429 $445.5100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 13 13 5.484778 $1311.9400 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 966 1142 993.545341 $49677.3700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 36 42 35.571782 $889.2900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2399 3574 4984.425859 $249221.5600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 96 133 407.044439 $10176.0900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 532 603 793.456363 $39672.9100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 20 21 43.311111 $1082.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 393 428 542.475406 $27123.8200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 5 5 3.700000 $92.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1251 1344 1487.400093 $74370.0400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 31 33 88.919070 $2222.9800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 4.416667 $323.8300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 65 70 459.271429 $11481.7900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 6 263.714286 $13185.7100 $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 1432 1604 9877.736937 $493886.7000 $50.0000
INTR -T1013 INTERPRETER 128 153 629.079853 $31453.9900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4112 6641 29741.010623 $297410.0000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 295 321 1923.646031 $137425.2900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 29 30 166.226192 $9508.1300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 283 305 1480.894461 $105795.0500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 28 30 163.935714 $9370.5600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 1.365905 $88.7800 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 2.000000 $474.2400 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
3 3 0.265753 $63.0000 $237.0700
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 1.444444 $684.9900 $474.2300
SENS -V5264 EARMOLD 8 8 3.822221 $68.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 681 748 4291.776605 $306604.4200 $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 16 16 130.571429 $1812.3300 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 3 4 8.892064 $4.4500 $0.5000
TRAV -TRAVS Travel by mile 1635 2611 161896.275862 $72043.8500 $0.4500
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Subtotal (Total Children Is Unduplicated) 7431 20075 220679.049090 $2073436.6700 $9.4000
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Total 21715 222221.753714 $2144494.9900 $9.6500
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Number of Children (Unduplicated) With at Least One Authorization 7816