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 21027 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 193 200 343.992328 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 8 32.024603 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 4.642857 $171.7900 $37.0000
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Subtotal (Total Children Is Unduplicated) 202 209 380.659788 $171.7900 $0.4500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 113 141 74.902278 $3632.7700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 3.955554 $186.2600 $47.0900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 41 42 31.751588 $609.6300 $19.2000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.655556 $5.7400 $8.7500
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 10 4.994446 $325.3500 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 25 25 10.892922 $278.1000 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 3.206393 $150.0600 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 8 6.039574 $722.3400 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 22 30 15.321497 $766.1000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 418 451 553.626748 $27681.3100 $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 11 11 6.933181 $520.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 16 16 9.677779 $725.8400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 12 6.827625 $512.0800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 19 12.577701 $698.0600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 74 74 70.210945 $5265.8800 $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 83 83 83.902100 $4656.5800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 47 48 45.941701 $3445.6400 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 12 13 5.961112 $304.3200 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 116 122 88.748928 $4530.6700 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 24 25 29.835281 $1523.0900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 66 68 23.838704 $1216.9700 $51.0500
SCREEN-T1023 SCREENING 7 8 1.685997 $84.3000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.155556 $18.0300 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.050000 $2.5500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.293150 $14.9700 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 176 181 99.593287 $5084.2700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 12 12 8.723940 $445.3600 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 4 4 1.794445 $89.7300 $50.0000
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Subtotal (Total Children Is Unduplicated) 1125 1461 1228.304808 $65354.5900 $53.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 58 70 28.441324 $142206.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 33 34 287.067677 $14353.3800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.511111 $36.6000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 10 10 3.339955 $798.9300 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 947 1101 682.497296 $34125.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 31 34 35.590835 $889.7700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2258 2845 3992.433487 $199621.5300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 132 154 234.637296 $5865.9300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 621 708 1000.758352 $50037.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 35 40 43.592857 $1089.8200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 537 590 763.128977 $38156.4700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 17 18 15.422224 $385.5600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1492 1591 1882.352027 $94117.5700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 92 103 216.914286 $5422.8600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 10.711111 $785.3400 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 29 34 207.157144 $5178.9300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 5 111.428572 $5571.4300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 12 13 70.452382 $3522.6300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1345 1498 9189.941613 $459497.3200 $50.0000
INTR -T1013 INTERPRETER 140 168 608.218832 $30410.9800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4164 6484 28561.949796 $285619.6100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 250 276 1724.831734 $123222.0200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 30 30 134.910315 $7716.8700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 223 242 1477.286156 $105537.3700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 26 28 196.592858 $11237.2500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 1.629376 $105.9000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 6.010959 $1425.3300 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
2 2 1.153425 $273.4900 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 5 5 3.294445 $1562.3800 $474.2500
SENS -V5264 EARMOLD 14 14 11.547337 $207.8500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 515 544 3343.941220 $238891.3000 $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 18 18 131.714285 $1828.2000 $13.8800
TRAV -TRAVS Travel by mile 1518 2685 166645.787043 $74157.3800 $0.4500
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Subtotal (Total Children Is Unduplicated) 7048 19357 221636.293926 $1944491.3300 $8.7700
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Total 21027 223245.258522 $2010017.7000 $9.0000
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Number of Children (Unduplicated) With at Least One Authorization 7405