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 22120 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 167 169 292.176982 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 11 12 32.467819 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 1.333334 $49.3400 $37.0000
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Subtotal (Total Children Is Unduplicated) 180 184 326.228135 $58.5900 $0.1800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 130 146 84.435456 $4095.1300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 0.688432 $32.4200 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.079452 $1.1900 $14.9400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 66 66 26.472222 $508.2700 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 1.529452 $15.9400 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 0.434246 $9.5300 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 5 1.723896 $15.0800 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.095890 $0.7700 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 0.723896 $15.8100 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 10 12 3.884323 $253.0300 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.496119 $11.3600 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 14 14 3.140865 $80.1800 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 9 3.217733 $150.5900 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 8 3.925875 $469.5400 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.066667 $133.3400 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 17 19 8.082645 $404.1400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 370 385 487.201633 $24360.0900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 20 20 18.157629 $1361.8200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 12 12 9.688887 $726.6500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 1.260881 $94.5700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 28 28 14.633180 $812.1300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 83 84 100.976019 $7573.2300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 29 29 34.743832 $2605.8000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 25 25 32.591324 $2444.3500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 131 132 162.772162 $9033.8600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 34 35 38.793758 $2909.5400 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.142857 $57.1500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 20 21 15.882366 $810.8000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 119 123 64.371128 $3286.1600 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 23 25 13.256272 $676.7200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 73 77 40.258231 $2055.2000 $51.0500
SCREEN-T1023 SCREENING 15 17 8.585324 $429.2800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 3 7.288889 $113.7100 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 2.136987 $109.0900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.322222 $67.5000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 185 191 121.056086 $6179.9000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 10 10 5.990151 $305.8000 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.177778 $8.8900 $50.0100
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Subtotal (Total Children Is Unduplicated) 1218 1530 1322.284765 $72218.5200 $54.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 68 72 53.784245 $268921.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 6 1.861111 $93.0600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 41 42 35.302457 $1765.1200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.372222 $26.6500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 10 10 3.139803 $751.0600 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 874 1051 628.110024 $31405.7400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 60 67 42.156772 $1053.9400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2486 3237 4039.326502 $201966.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 169 225 579.002385 $14475.0800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 741 861 1110.525486 $55526.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 15 15 36.544445 $913.6100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 563 596 779.164681 $38958.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 10 10 29.880952 $747.0300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1713 1846 2007.305940 $100365.2400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 108 125 357.126982 $8928.1900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 3 6.933334 $508.3600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 30 211.904760 $5297.6200 $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 6 7 44.695238 $2234.7700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1433 1602 9594.816065 $479740.6700 $50.0000
INTR -T1013 INTERPRETER 154 170 678.880006 $33944.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4037 6436 27180.528323 $271805.1200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 305 335 2010.403578 $143623.1900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 23 25 110.914285 $6344.2900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 294 315 1743.009529 $124520.5300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 35 39 182.793653 $10448.4800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 2.561644 $166.5100 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 2.000000 $237.1200 $118.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 6.463318 $1532.5800 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
2 2 2.079452 $493.0900 $237.1300
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 4 5 2.345510 $1112.3300 $474.2400
SENS -V5264 EARMOLD 18 21 11.607152 $208.9200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 670 720 4181.683338 $298739.4000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 26 26 285.857143 $3967.7000 $13.8800
TRAV -TRAVS Travel by mile 1593 2491 155732.773073 $69301.0900 $0.4500
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Subtotal (Total Children Is Unduplicated) 7599 20406 211859.567694 $2188308.3900 $10.3300
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Total 22120 213508.080594 $2260585.5000 $10.5900
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Number of Children (Unduplicated) With at Least One Authorization 8007