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
Eligibility Filter: Program Patients
With the filters selected there were 36779 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 172 174 296.721426 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 11 12 32.467819 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 13 13 6.566668 $242.9700 $37.0000
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Subtotal (Total Children Is Unduplicated) 196 200 336.005913 $252.2200 $0.7500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 150 167 91.992990 $4461.6700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 24 24 21.194779 $998.0500 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 13 13 12.988878 $193.9200 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 377 379 151.729376 $2913.2200 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 17 18 16.421146 $171.1100 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 56 56 21.729280 $476.9700 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 25 25 15.928374 $139.3700 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 8 8 9.575256 $77.1800 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 24 24 14.872819 $324.8200 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 7 7 9.479366 $273.9500 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 30 32 11.556091 $752.7800 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 2.416667 $92.7300 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 10 10 1.301597 $29.8100 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 21 21 12.086898 $308.5700 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 22 24 12.536790 $586.7200 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 30 30 25.361502 $3033.2400 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 2.066667 $258.3400 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 22 26 11.776479 $588.8300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 373 388 492.058776 $24602.9400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 0.723288 $54.2400 $74.9900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 67 78 77.877566 $5840.8400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 31 41 30.960958 $2322.0800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 18 18 19.271080 $1445.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 35 37 41.660804 $3124.5600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 67 90 71.915983 $3991.3500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 663 669 823.455049 $61759.5200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 238 238 238.163540 $17862.4400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 189 189 203.188559 $15239.2200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 621 624 920.737431 $51101.0300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 200 223 265.987659 $19949.0800 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.142857 $57.1500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 25 27 60.328574 $3016.4400 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 54 56 26.939289 $1375.2400 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 387 406 212.376150 $10841.8300 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 59 65 44.329007 $2262.9900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 311 325 150.912144 $7704.0700 $51.0500
SCREEN-T1023 SCREENING 58 60 39.263953 $1963.2100 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 4 7.311111 $114.0500 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 9 9 7.136987 $364.3400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 2.360578 $120.5100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 547 575 384.241640 $19615.5300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 31 31 26.225832 $1338.8200 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.177778 $58.8900 $50.0000
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Subtotal (Total Children Is Unduplicated) 3302 5031 4594.761548 $271806.9600 $59.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 182 193 124.452088 $622260.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 14 14 5.961111 $298.0600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 70 72 73.449196 $3672.4500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 7 7 7.381745 $528.6000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 34 34 19.805776 $4737.5900 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1064 1277 782.203484 $39110.4200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 120 127 70.909565 $1772.7600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2595 3366 4247.384439 $212369.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 170 226 579.441274 $14486.0500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 811 933 1239.918723 $61995.8700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 17 17 37.550001 $938.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 640 677 929.093971 $46454.6300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 11 11 30.014285 $750.3600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1817 1955 2221.400384 $111069.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 113 130 363.771427 $9094.3000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 15 16 29.802381 $2185.1100 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 25.142857 $628.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 285 321 3440.393648 $86009.8300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 163.714286 $8185.7100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 9 10 46.524396 $2326.2300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6711 7449 43746.279243 $2187313.2300 $50.0000
INTR -T1013 INTERPRETER 158 175 702.484767 $35124.2300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4046 6456 27292.029174 $272920.1300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1203 1326 7264.077792 $518945.6200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 128 143 682.090479 $39015.5600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1194 1288 6709.728878 $479342.9100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 95 103 451.038518 $25781.3600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 10 3.611644 $234.7600 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 4 4 2.640791 $313.0900 $118.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 16 16 13.823289 $3277.7800 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
4 4 2.210959 $524.2700 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 12 14 8.809621 $4177.8600 $474.2400
SENS -V5264 EARMOLD 63 68 66.451411 $1196.1200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2304 2526 13874.592475 $991200.7400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 22.857143 $1307.4300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 55 56 416.145443 $5776.1000 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 2 3 5.285714 $2.6400 $0.5000
TRAV -TRAVS Travel by mile 1601 2513 156274.525195 $69542.1700 $0.4500
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Subtotal (Total Children Is Unduplicated) 10127 31548 271976.997573 $5864870.4800 $21.5600
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Total 36779 276907.765034 $6136929.6700 $22.1600
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Number of Children (Unduplicated) With at Least One Authorization 11108