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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 14449 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 0.250000 $9.2500 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 132 134 243.267460 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 10 11 32.465079 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 142 146 275.982539 $9.2500 $0.0300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 108 121 72.365213 $3509.7300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.032877 $1.5500 $47.1200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 41 41 17.144444 $329.1700 $19.2000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.100000 $2.2000 $21.9500
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 4 0.566667 $36.9100 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 11 11 2.668339 $68.1200 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 4 2.472223 $115.7000 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 2.301674 $275.2800 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 16 18 7.660727 $383.0400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 263 275 345.203905 $17260.2200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 11 4.972222 $372.9200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 7 7 2.177777 $163.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 1.244444 $93.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 20 20 6.441628 $357.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 13 13 17.612327 $1320.9300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 7.510958 $563.3300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 5.505479 $412.9100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 18 18 24.030136 $1333.6800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 6 7 9.240334 $693.0200 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.142857 $57.1500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 5 5 2.300000 $117.4200 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 44 44 24.326789 $1241.8800 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 10 12 4.099924 $209.2900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 29 29 11.677169 $596.1300 $51.0500
SCREEN-T1023 SCREENING 8 8 4.216363 $210.8200 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 1.888889 $29.4700 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.084932 $4.3300 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 53 54 33.656546 $1718.1700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 3 3 1.076985 $54.9800 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.177778 $8.8900 $50.0100
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Subtotal (Total Children Is Unduplicated) 617 727 613.899606 $31541.3800 $51.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 28 31 14.197943 $70989.5000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 1.444444 $72.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 33 33 33.234117 $1661.7100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.101674 $263.5300 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 640 774 449.952165 $22497.7600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 44 49 29.948482 $748.7200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1904 2447 2902.408978 $145120.4000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 125 159 379.281745 $9482.0500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 511 595 746.611595 $37330.4900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 11 11 31.011111 $775.2800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 427 450 573.765871 $28688.2100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 10 10 29.880952 $747.0300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1211 1296 1361.864693 $68093.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 84 100 285.444442 $7136.1200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 2 0.533334 $39.1100 $73.3300
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 5 56.638094 $1415.9500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 91.571429 $4578.5700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 6 44.495238 $2224.7700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 203 233 1221.334918 $61066.7300 $50.0000
INTR -T1013 INTERPRETER 130 144 609.645955 $30482.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3058 4820 20243.127492 $202431.1400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 108 114 608.048415 $43438.9600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 15 16 69.957142 $4001.5500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 122 129 659.789686 $47135.3500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 15 16 90.207144 $5156.2400 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 0.561644 $36.5100 $65.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 4.301674 $1020.0200 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.079452 $18.8500 $237.2600
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 3 1.222222 $579.6200 $474.2300
SENS -V5264 EARMOLD 6 8 4.622221 $83.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 215 233 1267.652375 $90561.0700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 102.357142 $1420.7200 $13.8800
TRAV -TRAVS Travel by mile 1218 1865 110832.511416 $49320.4700 $0.4500
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Subtotal (Total Children Is Unduplicated) 5293 13576 142748.805205 $938617.3300 $6.5800
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Total 14449 143638.687350 $970167.9600 $6.7500
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Number of Children (Unduplicated) With at Least One Authorization 5521