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: 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 13755 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 156 162 293.375658 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 7 29.891270 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 163 169 323.266928 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 88 110 59.075110 $2865.1500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.394444 $18.5700 $47.0800
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 23 24 17.255555 $331.3100 $19.2000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.133333 $8.6800 $65.1200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 17 17 7.644444 $195.1600 $25.5300
EVAL -96111 DEVELOPMENTAL EVALUATION 21 28 15.310539 $765.5500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 300 324 408.384669 $20419.2300 $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 6 6 1.061035 $79.5800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 10 10 3.888890 $291.6800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 6 6 0.744368 $55.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 13 13 4.866667 $270.1000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 15 12.549313 $941.2100 $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 7 7 10.066667 $755.0000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 5 5 2.333333 $119.1100 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 38 39 21.033542 $1073.7800 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 7 7 13.834487 $706.2500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 24 24 6.803958 $347.3500 $51.0500
SCREEN-T1023 SCREENING 2 2 0.074201 $3.7100 $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 52 54 34.052991 $1738.4200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 6 6 6.160318 $314.4800 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 3 3 1.688889 $84.4500 $50.0000
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Subtotal (Total Children Is Unduplicated) 591 730 649.788823 $32775.2000 $50.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 26 12.231354 $61156.0000 $4999.9400
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 22 23 278.743074 $13937.1500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.511111 $36.6000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 0.821766 $196.5700 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 689 794 484.805369 $24240.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 25 27 26.574169 $664.3500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1705 2147 2923.400834 $146169.9000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 94 105 155.058725 $3876.4700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 436 495 699.183747 $34959.2000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 27 30 29.255555 $731.3900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 396 433 546.077785 $27303.9000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 12 13 11.772224 $294.3100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1069 1138 1357.443951 $67872.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 70 80 173.920634 $4348.0200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 7 77.076192 $1926.9000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 11 12 65.519049 $3275.9600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 189 209 1258.680944 $62934.0800 $50.0000
INTR -T1013 INTERPRETER 127 155 531.927638 $26596.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3114 4769 20766.453771 $207664.6400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 81 87 572.575389 $40904.8000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 14 14 70.892856 $4055.0700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 78 81 499.102386 $35655.8600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 8 27.542857 $1574.3500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 0.818265 $53.1800 $64.9900
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.153425 $36.3700 $237.0800
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 3 3 1.716667 $814.1300 $474.2500
SENS -V5264 EARMOLD 1 1 1.044444 $18.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 151 157 884.468208 $63186.4800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 11.047619 $631.9200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 16.000000 $222.0800 $13.8800
TRAV -TRAVS Travel by mile 1161 2030 126839.614007 $56443.6300 $0.4500
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Subtotal (Total Children Is Unduplicated) 4882 12856 158324.434015 $891781.1000 $5.6300
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Total 13755 159297.489766 $924556.3000 $5.8000
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Number of Children (Unduplicated) With at Least One Authorization 5134