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 20711 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 179 180 252.552591 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 18 18 60.170994 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 2.100000 $77.7000 $37.0000
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Subtotal (Total Children Is Unduplicated) 198 202 316.073585 $123.9500 $0.3900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 106 131 118.859062 $5764.6800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.305556 $14.3900 $47.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.624603 $24.2600 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 42 42 37.113493 $712.5800 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.624603 $16.9300 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 10.310317 $226.3100 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 2.624603 $22.9700 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 1.624603 $13.0900 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 2.624603 $57.3200 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.624603 $46.9500 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 10 12 6.541269 $426.0900 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $22.9000 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 20 20 10.716687 $273.5900 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 7 3.039878 $142.2700 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 2.970320 $355.2500 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.066667 $133.3400 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 12 14 7.571611 $378.5800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 340 354 563.064731 $28153.2300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 7.744137 $580.8100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 20 20 10.783334 $808.7600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.216667 $16.2500 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 13 14.308501 $1073.1500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 25 25 23.064134 $1280.0600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 82 83 99.895882 $7492.2200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 28 28 34.543832 $2590.8000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 24 24 32.524657 $2439.3500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 129 130 160.172162 $8889.5600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 34 35 36.830288 $2762.2800 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 3.285714 $164.2900 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 19 19 5.913469 $301.8700 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 100 103 68.045678 $3473.7400 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 21 23 6.504870 $332.0600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 46 53 34.096774 $1740.6600 $51.0500
SCREEN-T1023 SCREENING 10 11 5.434019 $271.7000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 4 3.955556 $61.7100 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 4.136987 $211.1900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 122 127 64.041545 $3269.3300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 8 8 3.382541 $172.6800 $51.0500
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Subtotal (Total Children Is Unduplicated) 1028 1337 1395.187956 $74893.2200 $53.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 59 73 44.060446 $220301.5000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 2.588889 $129.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 18 100.593663 $5029.6900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 3.333333 $238.7000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 4.556545 $1089.9400 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 841 1034 627.136278 $31357.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 59 65 28.324538 $708.1200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2288 2831 4016.996251 $200849.7300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 156 170 430.598413 $10764.9700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 787 937 1528.805862 $76440.2300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 33 44 49.515872 $1237.9000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 563 610 927.754667 $46387.6800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 13 15 17.806348 $445.1600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1680 1775 2304.314360 $115215.6900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 139 159 425.360320 $10634.0200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 5.866667 $430.1500 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 19 23 106.157144 $2653.9300 $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 5 8 33.857141 $1692.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1348 1514 9606.769858 $480338.3400 $50.0000
INTR -T1013 INTERPRETER 133 155 627.415819 $31370.7700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3805 6014 28391.050507 $283910.2900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 260 276 1784.121827 $127457.6100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 33 36 207.607140 $11875.1400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 235 247 1447.755953 $103427.6900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 23 24 138.636509 $7924.4600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 0.246575 $16.0300 $65.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 5.315069 $1260.3200 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 8 10 6.924200 $3283.7300 $474.2400
SENS -V5264 EARMOLD 15 18 15.282345 $275.0800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 563 604 3766.930963 $269109.5500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.285714 $73.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 17 17 191.423811 $2656.9600 $13.8800
TRAV -TRAVS Travel by mile 1395 2466 170112.317982 $75699.9900 $0.4500
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Subtotal (Total Children Is Unduplicated) 6910 19172 227093.996722 $2130950.4600 $9.3800
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Total 20711 228805.258263 $2205967.6400 $9.6400
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Number of Children (Unduplicated) With at Least One Authorization 7284