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: 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 34331 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 2 2 1.250000 $46.2500 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 181 182 267.552591 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 18 18 60.170994 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 11 11 14.034922 $519.3000 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 209 213 343.008507 $565.5500 $1.6500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 120 146 125.869565 $6104.7000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 17 17 9.855555 $464.1000 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 14 15 10.222223 $152.6200 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 309 313 247.938893 $4760.4300 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 15 10.750000 $112.0100 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 60 62 43.856111 $962.6400 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 24 25 13.048629 $114.1800 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 11 12 6.222223 $50.1500 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 23 24 12.648629 $276.2500 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 11 12 7.222223 $208.7200 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 36 39 16.107936 $1049.2700 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 1.101370 $42.2600 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 13 13 5.993073 $137.2400 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 31 32 19.436529 $496.2100 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 16 19 20.509719 $959.8500 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 22 23 22.666188 $2710.8700 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 4 4 5.066667 $633.3400 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 4 4 4.533333 $566.6600 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 15 18 8.749236 $437.4700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 343 357 567.921874 $28396.0800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.227778 $17.0900 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 53 57 58.417954 $4381.3500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 30 46 28.416515 $2131.2500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 18 18 18.798858 $1409.9200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 37 43 50.856749 $3814.2500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 61 78 87.331312 $4846.8900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 656 663 670.647515 $50298.9600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 236 236 215.142612 $16135.8700 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 188 188 203.121892 $15234.2200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 612 615 739.226341 $41027.1600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 198 221 253.996411 $19049.7400 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 3.285714 $164.2900 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.444444 $22.2200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 25 28 105.381748 $5269.0800 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 43 45 17.180411 $877.0600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 382 397 223.064514 $11387.4300 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 58 62 16.678007 $851.4000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 251 268 282.163403 $14404.4600 $51.0500
SCREEN-T1023 SCREENING 44 45 33.505948 $1675.3000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 4 3.955556 $61.7100 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 15 15 11.254795 $574.5600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 8 8 4.951066 $252.7500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 484 500 397.318547 $20283.1200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 26 26 29.320386 $1496.8000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2979 4719 4614.408452 $264301.9100 $57.2800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 155 177 140.677467 $703388.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 13 13 9.222222 $461.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 41 41 120.512927 $6025.6400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 7 7 5.605556 $401.4200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 41 41 20.715601 $4955.2000 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1024 1250 920.196219 $46010.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 111 117 53.905719 $1347.6600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2390 2950 4259.777995 $212988.8100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 157 171 430.670635 $10766.7700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 837 991 1657.657776 $82882.8200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 35 46 50.521428 $1263.0400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 627 683 1061.913255 $53095.6200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 16 17.939681 $448.4900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1772 1876 2535.015148 $126750.7000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 143 163 429.171431 $10729.3000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 9 11 33.397621 $2448.7300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 237 261 3134.549206 $78363.7000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 133.285713 $6664.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 7 10 40.852379 $2042.6200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6330 6948 44630.051123 $2231501.4000 $50.0000
INTR -T1013 INTERPRETER 136 160 644.592009 $32229.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3815 6032 28464.807651 $284647.8600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1070 1178 6755.774947 $482632.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 139 154 840.721426 $48089.3000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1070 1159 6320.030964 $451502.8500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 76 81 488.849210 $27942.5900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 0.562937 $36.5900 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 11 12 12.315069 $2920.1600 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.361644 $85.7400 $237.0900
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 16 18 21.946552 $10407.9100 $474.2400
SENS -V5264 EARMOLD 49 53 71.751544 $1291.5300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2047 2240 13526.957614 $966365.6800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 14.571429 $833.4800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 44 46 354.921433 $4926.3100 $13.8800
TRAV -TRAVS Travel by mile 1402 2481 170400.698935 $75828.3200 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 9282 29399 287604.502466 $5972276.0500 $20.7700
-------------------------------------------------------------------------------------------------------------------------------------
Total 34331 292561.919425 $6237143.5000 $21.3200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 9845