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: 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 22289 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 2 2 1.107143 $40.9600 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 212 218 293.270633 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 9 17.702380 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 222 229 312.080156 $40.9600 $0.1300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 95 113 86.869108 $4213.1300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.898413 $200.1900 $51.3500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 41 43 42.222223 $901.4500 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.162100 $14.6500 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.238356 $26.6900 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 5 4.103652 $33.9000 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 1.170319 $29.6200 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 2.972222 $229.2500 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.933333 $89.7400 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.336986 $6.2500 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 4.039877 $83.5400 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.872222 $39.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 2.805555 $322.6300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 20 26 24.955085 $1247.7600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 463 490 672.175321 $33608.7600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.127778 $9.5900 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 11 13.461112 $1009.5900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 17 17 7.405556 $555.4200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 4.186073 $313.9500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 25 25 18.744446 $1405.8500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 31 31 12.112177 $672.2300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 97 97 79.765743 $5982.4700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 26 27 32.189432 $2414.2100 $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 132 132 107.489039 $5965.6400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 47 47 44.499601 $3337.4900 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.566667 $28.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 2.833333 $141.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 21 21 7.155556 $365.2900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 10.718286 $547.1700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 24 24 17.316666 $884.0100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 86 87 57.316474 $2926.0300 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.166667 $8.5100 $51.0600
PSTF -97164 PT RE-EVAL EST PLAN CARE 22 23 16.930954 $864.3300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.644444 $186.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 11 5.149772 $262.9000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 43 46 25.611917 $1307.5000 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 0.616667 $31.4800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.344444 $17.5800 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 171 180 115.767860 $5909.9500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 22 22 27.828626 $1420.6600 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.213699 $10.6900 $50.0000
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Subtotal (Total Children Is Unduplicated) 1199 1570 1516.978038 $81619.8900 $53.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 40 45 22.725341 $113627.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.933333 $96.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 16 17 6.083029 $304.1500 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 11 11 6.458068 $1485.3900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 929 1071 584.261212 $29213.3700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 42 45 22.708388 $567.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2526 3113 4329.747875 $216487.2400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 188 197 252.392018 $6309.8000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 815 956 1326.667468 $66333.4100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 60 87 71.914288 $1797.8600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 629 718 957.068490 $47853.5200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 54 43.038893 $1075.9800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1868 1982 2468.909146 $123445.3500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 158 162 202.087670 $5052.1900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 12.793651 $938.0400 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 54 63 283.576183 $7089.4300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 51.428571 $2571.4300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 11 13 54.350000 $2717.5000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1215 1329 8661.858633 $433093.1300 $50.0000
INTR -T1013 INTERPRETER 144 187 638.069660 $31903.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4336 6647 30324.442013 $303244.5200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 220 228 1313.447616 $93832.7500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 24 25 163.335716 $9342.8000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 187 200 1093.853968 $78144.9200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 17 18 118.071427 $6748.9800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 0.601674 $39.1100 $65.0000
SENS -V5060 BEHIND EAR HEARING AID
1 1 1.933333 $440.7900 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
4 4 3.655556 $1666.9500 $456.0100
SENS -V5264 EARMOLD 9 9 6.859588 $123.4700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 469 499 3105.816645 $221879.6700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 13.000000 $743.6000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 19 19 292.714283 $4062.8700 $13.8800
TRAV -TRAVS Travel by mile 1545 2776 171461.562492 $76300.4000 $0.4500
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Subtotal (Total Children Is Unduplicated) 7565 20490 227897.366228 $1888533.4900 $8.2900
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Total 22289 229726.424422 $1970194.3300 $8.5800
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Number of Children (Unduplicated) With at Least One Authorization 7956