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: 07-01-17 and 09-30-17 Date of Report: 11-04-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 37684 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 225 232 426.591264 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 6 7 8.800000 $325.6000 $37.0000
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Subtotal (Total Children Is Unduplicated) 231 239 435.391264 $325.6000 $0.7500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 156 183 90.179790 $4373.7400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 12 12 8.292064 $425.8000 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 2.144444 $38.4300 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 377 381 438.903718 $9370.5900 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 13 13 5.804872 $73.2000 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 48 48 35.607163 $767.3300 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 35 36 17.515526 $144.6800 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.022222 $0.2000 $9.0500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 38 38 18.937748 $479.3100 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 6 4.345510 $151.9600 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 12 12 4.675418 $360.6100 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 5.571429 $258.6200 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 23 23 8.815525 $163.5300 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 15 15 10.199999 $210.9300 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 19 19 152.896151 $6880.3200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 24 24 156.426668 $17989.0500 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 3.571429 $446.4300 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 28 36 22.052434 $1102.6200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 489 516 661.943526 $33097.2000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 7 6.020547 $451.5500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 63 68 55.965216 $4197.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 21 23 23.973438 $1798.0100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 13 6.130289 $459.7700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 42 47 38.832497 $2912.4400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 39 45 38.362650 $2129.1400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 661 661 904.402104 $67830.3100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 267 267 431.315246 $32348.7100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 182 182 212.188768 $15914.2100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 671 671 923.497773 $51254.1600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 390 402 522.516417 $39188.7900 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 17 17 45.712697 $2285.6400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 63 65 15.124060 $772.1000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 24 24 20.450533 $1044.0000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 99 100 67.975648 $3470.1600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 394 415 213.632682 $10905.9900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 66 66 30.314055 $1547.5200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.087671 $4.4800 $51.0700
PSTH -97161 PT EVAL LOW COMPLEXITY 12 12 5.129984 $261.8900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 36 37 28.907903 $1475.7500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 296 320 111.823887 $5708.6300 $51.0500
SCREEN-T1023 SCREENING 37 39 32.853273 $1642.6700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 5 3.415981 $51.2400 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 9 9 40.357991 $2060.2700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 12 12 3.884703 $198.3100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 665 720 404.486746 $20649.1100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 106 108 47.136405 $2406.3300 $51.0500
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Subtotal (Total Children Is Unduplicated) 3633 5706 5882.404800 $349303.1000 $59.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 161 180 115.518398 $577593.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 7 5.331507 $266.5800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 64 64 62.732990 $3136.6600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 7 7 3.138889 $224.7800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 46 46 23.253730 $5348.4000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1037 1193 796.224518 $39811.5300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 117 120 64.694114 $1617.3700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2536 3109 4085.246286 $204262.2400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 162 178 178.151981 $4453.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 859 994 1300.611869 $65030.5400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 63 91 87.243646 $2181.0800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 645 718 875.863953 $43793.1700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 31 47 45.011112 $1125.2800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1880 2007 2458.561676 $122928.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 144 154 174.517066 $4362.9300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 9 40.819047 $2992.8500 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 3 3.666667 $0.0000 $0.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 27.428571 $685.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 346 415 4270.576212 $106764.3000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 83.428571 $4171.4300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 7 8 40.833333 $2041.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6806 7515 46021.452173 $2301071.3400 $50.0000
INTR -T1013 INTERPRETER 151 192 653.784369 $32689.2300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4215 6377 30455.871397 $304558.5100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1194 1309 7056.591086 $504122.7900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 182 192 1125.686900 $64389.2800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1181 1275 6361.661787 $454477.0000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 85 92 479.828573 $27426.9900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 1.162557 $75.5700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.738204 $198.1500 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 10 10 3.995815 $911.0200 $227.9900
SENS -V5060 BEHIND EAR HEARING AID
3 3 1.189042 $271.1100 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
17 17 9.928386 $4527.3500 $456.0000
SENS -V5264 EARMOLD 57 57 187.193186 $3369.4800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2254 2490 14672.249521 $1048185.1600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 5.725245 $327.4900 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 70 71 352.119046 $4887.4000 $13.8800
TRAV -TRAVS Travel by mile 1529 2775 189757.951298 $84442.3000 $0.4500
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Subtotal (Total Children Is Unduplicated) 9996 31739 311890.982721 $6028722.0300 $19.3300
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Total 37684 318208.778785 $6378350.7400 $20.0400
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Number of Children (Unduplicated) With at Least One Authorization 10610