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 22245 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 194 198 786.892862 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 10 71.571427 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.166667 $43.1700 $37.0000
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Subtotal (Total Children Is Unduplicated) 201 210 861.330956 $106.0700 $0.1200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 140 165 101.522810 $4923.8700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 3.571429 $183.3900 $51.3500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 25 25 18.277779 $390.2300 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 0.102740 $1.3000 $12.6000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 1.049467 $22.6200 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 0.147184 $1.2200 $8.2500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 0.147184 $3.7200 $25.3000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 7 8 3.555555 $274.2400 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.047184 $0.8700 $18.5200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 14 14 7.611949 $157.4100 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 1.358980 $61.1500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 5.714536 $657.1700 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 0.123288 $15.4100 $125.0100
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 2 2.000000 $250.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 14 22 21.238429 $1061.9300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 449 463 578.078837 $28903.9300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.328767 $24.6600 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 17 17 12.338357 $925.3900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 29 30 12.355555 $926.6600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 28 28 15.199619 $1139.9700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 50 51 21.400837 $1187.7400 $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 29 29 14.150681 $1061.3100 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 0.286073 $14.3000 $49.9900
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 7 7 2.546118 $129.9700 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 22 25 7.227170 $368.9500 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 17 17 11.861187 $605.5100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 7 8 1.405175 $71.7300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 12 6.600630 $336.9700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 69 80 62.199208 $3175.2900 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 6 6 1.913851 $97.7000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 19 23 7.622223 $389.1200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 13 13 5.162785 $263.5600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 7 2.633258 $134.4200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 4.959360 $253.1800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 53 68 44.907470 $2292.5300 $51.0500
SCREEN-T1023 SCREENING 4 4 2.144292 $107.2200 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 3.194445 $163.0800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 158 168 151.984615 $7758.8400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 15 15 13.317298 $679.8500 $51.0500
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Subtotal (Total Children Is Unduplicated) 1245 1602 1388.567369 $74843.3800 $53.9000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 63 73 48.718274 $243591.0000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.088889 $4.4500 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 19 6.416362 $320.8200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.041096 $2.9400 $71.6200
AUDE -V5160 DISPENSING FEE BINAURAL 12 12 6.243759 $1436.0500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 875 1062 593.653428 $29682.8800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 40 41 11.994676 $299.8800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2331 2925 4246.782238 $212339.0700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 165 174 274.020627 $6850.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 834 1000 1391.180931 $69558.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 47 60 47.275399 $1181.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 590 647 930.134387 $46506.6900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 23 32 23.549999 $588.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1703 1809 2302.608432 $115130.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 132 148 255.499994 $6387.5000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.100000 $7.3300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 30 40 167.823808 $4195.6000 $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 8 8 58.427777 $2921.3900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1383 1505 9469.423527 $473471.3800 $50.0000
INTR -T1013 INTERPRETER 154 179 633.493090 $31674.6600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4414 6768 30753.016294 $307530.2800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 228 247 1540.171611 $110029.8500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 25 28 183.642859 $10504.3800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 228 245 1551.842854 $110863.6800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 18 18 86.335715 $4934.9500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 2.052055 $133.3900 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 2.610426 $595.1700 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
2 2 3.000000 $684.0000 $228.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 2.422222 $1104.5200 $456.0000
SENS -V5264 EARMOLD 13 13 8.717123 $156.9100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 509 556 3412.956072 $243821.7100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 17 17 168.314283 $2336.2100 $13.8800
TRAV -TRAVS Travel by mile 1552 2791 167998.436019 $74759.3100 $0.4500
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Subtotal (Total Children Is Unduplicated) 7357 20433 226232.751368 $2116194.2600 $9.3500
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Total 22245 228482.649693 $2191143.7100 $9.5900
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Number of Children (Unduplicated) With at Least One Authorization 7810