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: 04-01-17 and 06-30-17 Date of Report: 08-05-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 22750 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 0.107143 $3.9600 $36.9900
SCONLY-SCONLY *SERVICE COORDINATION ONLY 189 194 649.122651 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 12 12 65.873014 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 2.588889 $95.7900 $37.0000
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Subtotal (Total Children Is Unduplicated) 202 209 717.691697 $99.7500 $0.1400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 133 157 194.287848 $9422.9700 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.361340 $6.4800 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 49 49 43.338889 $925.2900 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 0.539118 $6.8000 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.677778 $14.6100 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 0.539118 $4.4500 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.177778 $1.6100 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 0.563775 $14.2700 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.177778 $6.2200 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 9 3.788889 $292.2400 $77.1300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 17 17 8.125723 $168.0400 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 0.690487 $31.0700 $44.9900
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 0.895966 $103.0300 $114.9900
EVAL -96111 DEVELOPMENTAL EVALUATION 17 23 24.261249 $1213.0700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 479 508 675.007213 $33750.3800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.241096 $18.0800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 16 15.529985 $1164.7500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 27 29 9.188893 $689.2000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 3.297184 $247.2800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 18 18 17.260318 $1294.5200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 33 34 15.633608 $867.6800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 99 99 81.847935 $6138.6400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 27 28 34.189432 $2564.2100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 42 42 53.060277 $3979.5100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 131 131 107.401368 $5960.7700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 48 48 44.581793 $3343.6600 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.566667 $28.3400 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 7 7 2.341325 $119.5300 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 15 17 5.195968 $265.2600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 25 25 7.607231 $388.3500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 0.861416 $43.9800 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 15 15 8.264993 $421.9300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 70 71 34.124258 $1742.0600 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.255556 $13.0500 $51.0600
PSTF -97164 PT RE-EVAL EST PLAN CARE 19 20 7.855556 $401.0300 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 20 21 8.097565 $413.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.216667 $62.1100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 4.846575 $247.4200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 28 29 11.090486 $566.1600 $51.0500
SCREEN-T1023 SCREENING 6 6 4.386910 $219.3500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.088889 $1.3300 $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 1.344444 $68.6300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 177 185 91.828226 $4687.8300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 12 12 5.003272 $255.4100 $51.0500
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Subtotal (Total Children Is Unduplicated) 1286 1668 1532.640842 $82276.0600 $53.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 65 72 39.432514 $197161.0000 $4999.9600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.555555 $77.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 19 16.788477 $839.4300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 3.238889 $231.9400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 12 12 4.749088 $1092.2900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 918 1107 622.013459 $31100.9400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 38 44 16.604049 $415.1100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2483 3116 4121.264692 $206063.3600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 171 192 276.556750 $6913.9200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 791 916 1245.050388 $62252.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 44 59 50.807141 $1270.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 645 707 955.939689 $47797.0100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 25 39 33.011109 $825.2700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1843 1970 2374.151784 $118707.5300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 126 137 237.336085 $5933.3900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.200000 $87.9800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 25 33 163.557146 $4088.9300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 158.571429 $7928.5700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 10 12 74.408732 $3720.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1416 1573 9582.707877 $479135.2000 $50.0000
INTR -T1013 INTERPRETER 149 175 603.865853 $30193.2800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4117 6597 28832.979403 $288329.6200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 292 306 1674.994815 $119661.5100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 21 22 118.078571 $6754.1000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 278 289 1482.630948 $105919.1300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 20 21 120.976191 $6915.0000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 4.702283 $305.6500 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.126027 $14.3600 $113.9800
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 4.762633 $1085.8700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
8 8 5.029833 $2293.5400 $455.9900
SENS -V5264 EARMOLD 19 20 10.772831 $193.9100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 603 657 3920.438107 $280075.9800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 19 19 124.423807 $1727.0100 $13.8800
TRAV -TRAVS Travel by mile 1703 2730 161745.017766 $71976.5400 $0.4500
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Subtotal (Total Children Is Unduplicated) 7591 20873 218627.743921 $2091088.2400 $9.5600
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Total 22750 220878.076460 $2173464.0500 $9.8400
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Number of Children (Unduplicated) With at Least One Authorization 8055