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: 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 36583 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 198 202 794.802386 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 10 71.571427 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 6.033335 $223.2400 $37.0000
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Subtotal (Total Children Is Unduplicated) 212 221 874.107148 $286.1400 $0.3300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 162 191 108.834378 $5278.4600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 11 7.376984 $378.8000 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 8 8 5.850000 $104.8300 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 135 136 110.433333 $2357.7500 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 13 14 6.714916 $84.6700 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 73 74 55.121012 $1187.8600 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 28 28 10.363469 $85.6000 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 4 4 3.205556 $29.0400 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 29 29 11.724809 $296.7500 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 9 9 8.311111 $290.6400 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 23 24 11.640789 $897.8400 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 5 5 4.016438 $186.4400 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 25 26 8.191018 $151.9400 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 36 36 18.939499 $391.6700 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 18 18 10.967048 $493.5200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 31 33 16.254034 $1869.2200 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 0.123288 $15.4100 $125.0100
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 4 2.322223 $290.2900 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 21 35 29.430206 $1471.5300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 452 466 579.448244 $28972.4000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 0.334246 $25.0700 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 75 82 109.822325 $8236.6900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 49 78 50.087060 $3756.5300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 7.021916 $526.6500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 65 83 68.997945 $5174.8400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 94 131 89.636074 $4974.8000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 701 701 805.364627 $60402.5300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 329 330 458.981471 $34423.7300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 179 180 194.414279 $14581.0900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 631 634 692.338336 $38424.7800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 278 284 310.419169 $23281.4600 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 0.286073 $14.3000 $49.9900
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.633333 $131.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 17 18 33.237299 $1661.8800 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 25 25 8.722681 $445.3000 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 61 65 18.829637 $961.2600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 95 98 59.866392 $3056.1700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 21 23 9.368646 $478.2700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 54 57 33.980538 $1734.7200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 278 330 195.602474 $9985.5100 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 19 20 5.252816 $268.1500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 45 52 14.768950 $753.9600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 61 61 41.710121 $2129.3100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 23 24 12.950611 $661.1300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 39 41 22.752965 $1161.5400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 256 312 171.835675 $8772.2400 $51.0500
SCREEN-T1023 SCREENING 45 47 34.467883 $1723.3900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 5 3.265526 $48.9800 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 6.713166 $342.7100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 13 13 5.799925 $296.0900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 571 607 401.055305 $20473.9100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 45 45 27.780770 $1418.2200 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.411111 $20.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 3376 5524 4907.977700 $295182.0800 $60.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 184 205 99.192166 $495958.5000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 13 13 5.865373 $293.2700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 66 66 36.116133 $1805.8200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 8 8 7.923637 $567.4200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 44 45 22.283180 $5125.0900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1003 1216 722.183906 $36109.4300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 95 99 44.079942 $1102.0100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2380 2983 4304.387793 $215219.3700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 166 175 275.020627 $6875.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 850 1017 1403.897598 $70194.7800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 48 61 48.275399 $1206.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 617 677 955.354948 $47767.7300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 24 33 24.549999 $613.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1754 1864 2360.168749 $118008.3800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 135 152 261.399994 $6535.0000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 10 29.360320 $2152.7100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 233 274 2734.485708 $68362.1600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 51.757142 $2587.8600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 13 13 62.034170 $3101.7100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6670 7259 44255.442552 $2212773.3600 $50.0000
INTR -T1013 INTERPRETER 154 179 633.493090 $31674.6600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4415 6776 30778.602007 $307786.1400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1036 1139 6213.481316 $443891.2200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 159 178 977.066661 $55888.2400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1059 1155 6194.111409 $442507.5100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 62 63 270.344045 $15452.8900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 2.580822 $167.7600 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.482192 $168.9700 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 16 18 6.094444 $1389.5200 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
8 8 6.794902 $1549.2400 $228.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 11 11 9.505480 $4334.4600 $456.0000
SENS -V5264 EARMOLD 62 65 45.908374 $826.3600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2001 2204 12519.669553 $894405.6700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 35.428572 $2026.5200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 52 54 375.346833 $5209.8200 $13.8800
TRAV -TRAVS Travel by mile 1553 2801 168380.431256 $74929.3000 $0.4500
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Subtotal (Total Children Is Unduplicated) 9590 30838 284154.120292 $5578568.9800 $19.6300
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Total 36583 289936.205140 $5874037.2000 $20.2600
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Number of Children (Unduplicated) With at Least One Authorization 10296