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
Eligibility Filter: Program Patients
With the filters selected there were 35330 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 197 206 348.627250 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 8 32.024603 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 16 16 17.287303 $639.6400 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 221 230 397.939156 $639.6400 $1.6100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 132 161 79.526632 $3857.0400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 18 18 7.299998 $343.7500 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 6 6 7.381747 $110.2100 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 205 211 143.144447 $2748.3800 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 9 9 9.842857 $102.5600 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 62 62 29.569755 $649.0600 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 28 28 24.091227 $210.8000 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 4 4 7.059524 $56.9000 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 31 31 23.340432 $509.7600 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 6.059524 $175.1200 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 31 32 13.738891 $894.9700 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $38.3700 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 21 21 4.329757 $99.1500 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 31 31 18.730223 $478.1800 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 23 23 13.621310 $637.4900 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 34 35 17.833712 $2132.8900 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 27 36 16.858407 $842.9400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 418 451 553.626748 $27681.3100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 3 0.232876 $17.4600 $74.9800
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 59 64 66.528057 $4989.6200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 33 44 27.140562 $2035.5700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 10.510653 $788.3000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 46 54 52.334779 $3925.1200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 55 71 54.293010 $3013.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 674 675 653.942885 $49046.1800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 258 258 177.454734 $13309.3700 $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 593 596 741.320172 $41143.3600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 264 277 344.707251 $25853.0600 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 17 17 52.385713 $2619.2900 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 40 42 23.044967 $1176.4600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 386 399 239.295290 $12216.0700 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 55 56 42.211189 $2154.8900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 278 287 172.624688 $8812.4800 $51.0500
SCREEN-T1023 SCREENING 51 53 33.562365 $1678.1300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 5 3.344977 $52.1800 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 2.195205 $112.0700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 2.604262 $132.9500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 517 541 299.165120 $15272.4100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 41 42 33.992281 $1735.3100 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 5 5 2.016667 $100.8400 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3086 4835 4151.300759 $242171.7400 $58.3400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 157 179 73.813783 $369068.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 7 2.265752 $113.2900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 73 74 310.712807 $15535.6400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 1.194444 $85.5300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 26 26 11.980768 $2865.8100 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1132 1320 824.187149 $41209.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 86 92 60.769999 $1519.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2371 2977 4258.359678 $212917.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 133 156 234.986503 $5874.6600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 693 791 1158.531366 $57926.5800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 35 40 43.592857 $1089.8200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 603 662 920.927390 $46046.3700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 17 18 15.422224 $385.5600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1596 1712 2126.204411 $106310.1900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 98 109 225.870636 $5646.7700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 9 10 26.599999 $1950.3000 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 58.285715 $1457.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 358 424 4074.076222 $101851.9300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 6 130.857143 $6542.8600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 15 16 71.696413 $3584.8300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6517 7176 43670.856396 $2183544.3800 $50.0000
INTR -T1013 INTERPRETER 141 169 608.229791 $30411.5300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4175 6516 28737.629155 $287376.4100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1075 1179 6632.300513 $473811.6400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 135 140 699.381747 $40004.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1098 1192 6309.719101 $450766.3900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 84 90 443.951993 $25376.2800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 11 11 2.797717 $181.8400 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.894977 $106.1000 $118.5500
SENS -V5050 IN EAR MONAURAL HEARING AID 20 20 12.550054 $2975.8600 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
4 4 1.649316 $391.0800 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 12 12 5.199087 $2465.6200 $474.2400
SENS -V5264 EARMOLD 66 66 50.522776 $909.4100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2070 2283 12951.307196 $925241.7300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 7 33.047618 $1890.3300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 64 66 349.632138 $4852.9000 $13.8800
TRAV -TRAVS Travel by mile 1523 2707 169152.434658 $75272.8400 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 9546 30265 284292.439492 $5487561.3000 $19.3000
-------------------------------------------------------------------------------------------------------------------------------------
Total 35330 288841.679407 $5730372.6800 $19.8400
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 10119