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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 36655 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 1.700000 $62.9000 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 233 239 438.683597 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 10 10 54.902383 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 10 10 8.463492 $313.1500 $37.0000
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Subtotal (Total Children Is Unduplicated) 252 260 503.749472 $376.0500 $0.7500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 149 174 72.227021 $3503.0300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 19 19 6.377779 $327.5100 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 7 6.841270 $122.6000 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 318 318 224.949206 $4802.6700 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 10 10 8.205121 $103.4700 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 68 68 41.126476 $886.2800 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 29 30 14.725876 $121.6400 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 4 4 5.363492 $48.5900 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 32 33 32.695716 $827.5300 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 4.363492 $152.5900 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 37 38 17.113493 $1319.9700 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $46.4200 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 27 28 9.731431 $180.5200 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 32 32 21.893326 $452.7600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 30 30 18.627702 $838.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 34 37 42.049196 $4835.6800 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 0.123288 $15.4100 $125.0100
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 4 4.000000 $500.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 25 40 33.160039 $1658.0200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 416 432 653.937113 $32696.8500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 0.555479 $41.6600 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 72 80 71.047332 $5328.5600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 46 70 53.858063 $4039.3500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 9 19.450487 $1458.8000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 44 44 50.074733 $3755.6000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 75 95 85.104640 $4723.2900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 700 700 802.705723 $60203.1200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 328 329 458.004759 $34350.4800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 178 179 194.119835 $14559.0100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 632 635 696.568473 $38659.5500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 279 285 311.570387 $23367.8000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.002740 $0.1400 $49.2700
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 23 24 89.604761 $4480.2400 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 26 26 14.620201 $746.3600 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 14 14 4.846119 $247.4000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 270 276 147.336641 $7521.5300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 2.706697 $138.1800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 21 21 12.192868 $622.4500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 98 102 59.101892 $3017.1700 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 40 40 14.900348 $760.6500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 11 4.846270 $247.4000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 177 179 161.249708 $8231.8200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 3.962329 $202.2800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 11 7.246423 $369.9300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 98 106 52.172994 $2663.4400 $51.0500
SCREEN-T1023 SCREENING 48 51 31.007076 $1550.3500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 5 2.945510 $44.1800 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 13 13 8.449390 $431.3400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 3.055556 $155.9900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 587 610 404.962523 $20673.3700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 38 38 35.457957 $1810.1200 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 3 3 0.861111 $43.0600 $50.0000
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Subtotal (Total Children Is Unduplicated) 3478 5286 5023.400062 $297899.3400 $59.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 169 198 91.968158 $459841.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 11 11 8.577779 $428.9000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 64 65 239.071126 $11953.5700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 9.571429 $685.4100 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 1.633333 $116.9600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 25 26 60.166904 $13838.3900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1050 1311 753.906218 $37695.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 101 106 47.807720 $1195.2100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2410 3031 4017.864150 $200893.0900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 148 166 358.601589 $8965.0400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 825 929 1366.848542 $68342.3900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 49 59 63.778571 $1594.4600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 659 717 927.499422 $46374.9300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 20 21 16.777776 $419.4400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1828 1967 2338.260421 $116913.0700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 138 157 355.391271 $8884.7900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 10 33.688888 $2470.0700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 304 344 3312.740474 $82818.5200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 163.042858 $8152.1500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 11 12 42.230953 $2111.5500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6511 7233 41959.765865 $2097988.9000 $50.0000
INTR -T1013 INTERPRETER 162 185 689.615532 $34480.7700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4097 6532 28007.330794 $280073.3600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1099 1210 6396.670323 $456978.1700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 139 153 809.998817 $46331.9200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1167 1266 6177.676188 $441333.2000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 81 82 370.645238 $21186.0800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 9 1.730442 $112.4900 $65.0100
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.389955 $44.4600 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 19 20 8.722603 $1988.7800 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
5 5 1.394521 $317.9500 $228.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 14 14 14.966906 $6825.0000 $456.0100
SENS -V5264 EARMOLD 66 69 50.256237 $904.6100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2185 2413 13410.098882 $958017.5400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 34.785713 $1989.7500 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 28 28 121.676193 $1688.8700 $13.8800
TRAV -TRAVS Travel by mile 1685 2741 184672.659518 $82179.3400 $0.4500
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Subtotal (Total Children Is Unduplicated) 9644 31109 296937.811309 $5506135.6600 $18.5400
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Total 36655 302464.960843 $5804411.0500 $19.1900
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Number of Children (Unduplicated) With at Least One Authorization 10816