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 22183 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 227 233 420.939153 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 10 10 54.902383 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 3.333333 $123.3300 $37.0000
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Subtotal (Total Children Is Unduplicated) 238 246 480.874869 $186.2300 $0.3900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 130 153 65.997264 $3200.8800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 1.961111 $100.7000 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 3.785714 $67.8400 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 51 51 45.643650 $974.4900 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 3.788454 $47.7700 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 3.785714 $81.5800 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 5.166232 $42.6700 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 3.785714 $34.3000 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 4.788454 $121.1900 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 3.785714 $132.3900 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 10 11 7.874603 $607.3700 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 2.002740 $37.1500 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 27 27 17.726659 $366.5900 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.120929 $50.4500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 6 26.954980 $3099.8400 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 0.123288 $15.4100 $125.0100
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 2 3 3.000000 $375.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 17 25 23.288429 $1164.4300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 415 431 652.937113 $32646.8500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 14 14 9.326257 $699.4800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 22 24 11.944444 $895.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 6 6 5.916286 $443.7200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 29 30 17.950837 $996.2700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 83 83 71.820770 $5386.5800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 21 21 28.032874 $2102.4800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 30 30 34.057535 $2554.3100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 116 116 102.369865 $5681.5100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 30 30 15.200681 $1140.0600 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.002740 $0.1400 $49.2700
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 8 8 1.926103 $98.3200 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 8 3.244445 $165.6300 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 62 63 40.521395 $2068.6100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 0.501674 $25.6100 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 1.463492 $74.7100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 25 26 11.008688 $562.0000 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 12 12 8.133529 $415.2100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 5 2.305556 $117.7000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 37 37 11.631127 $593.7700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 1.650000 $84.2300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.112785 $107.8600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 29 33 10.062787 $513.7200 $51.0500
SCREEN-T1023 SCREENING 7 8 2.443759 $122.1900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.911111 $28.6700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.055556 $53.8900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 175 179 109.433606 $5586.6100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 14 14 13.240128 $675.9100 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.566667 $28.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 1206 1503 1399.351459 $74492.3400 $53.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 62 78 32.663087 $163313.5000 $4999.9400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.511111 $25.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 24 24 213.954611 $10697.7300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 9.571429 $685.4100 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.005556 $0.4000 $72.1700
AUDE -V5160 DISPENSING FEE BINAURAL 5 6 1.819254 $418.4200 $229.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 912 1145 595.247732 $29762.6500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 47 48 17.533564 $438.3500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2323 2927 3833.316531 $191665.7000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 148 165 357.244446 $8931.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 777 881 1254.769959 $62738.4900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 48 58 62.778571 $1569.4600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 607 661 828.996321 $41449.8000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 19 20 15.777776 $394.4400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1746 1879 2175.691372 $108784.6200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 132 151 339.153176 $8478.8300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.600000 $263.9500 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 29 117.766669 $2944.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 139.328572 $6966.4300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 10 11 37.016667 $1850.8400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1411 1580 9109.611098 $455480.6500 $50.0000
INTR -T1013 INTERPRETER 160 183 678.186961 $33909.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4091 6507 27905.303808 $279053.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 260 280 1644.735119 $117499.8700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 33 36 187.409526 $10719.8100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 266 286 1453.697299 $103852.1300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 17 17 86.964287 $4970.8700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 0.428311 $27.8400 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.164384 $265.4800 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
2 2 1.098630 $250.4800 $227.9900
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 4 4 1.372223 $625.7700 $456.0300
SENS -V5264 EARMOLD 12 12 8.993150 $161.8800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 653 707 4165.687652 $297596.7100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 5.500000 $76.3400 $13.8800
TRAV -TRAVS Travel by mile 1681 2722 183153.659519 $81503.3900 $0.4500
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Subtotal (Total Children Is Unduplicated) 7369 20434 238440.558371 $2027373.4900 $8.5000
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Total 22183 240320.784699 $2102052.0600 $8.7500
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Number of Children (Unduplicated) With at Least One Authorization 7861