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 21819 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 221 228 422.705550 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.811111 $30.0100 $37.0000
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Subtotal (Total Children Is Unduplicated) 222 229 423.516661 $30.0100 $0.0700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 129 153 78.302241 $3797.6800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.794445 $40.8000 $51.3500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 81 82 81.800000 $1746.4300 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.100000 $13.8700 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.323288 $6.9700 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 7 4.262101 $35.2100 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 3.306545 $83.6900 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.323288 $46.2800 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 5 2.897641 $223.5000 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 1.206545 $22.3800 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 3.288888 $68.0100 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 147.954142 $6657.9400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 148.587475 $17087.5600 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 3.571429 $446.4300 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 22 27 16.653652 $832.6800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 485 511 656.143526 $32807.2000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 5.019330 $376.4500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 0.638889 $47.9200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 2.009589 $150.7200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 2.771689 $207.8800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 8 2.838279 $157.5300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 54 54 52.628763 $3947.1800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 21 21 23.042463 $1728.2000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 35 35 34.149508 $2561.2200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 95 95 80.409592 $4462.7200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 45 45 48.191775 $3614.4000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 19 19 3.744446 $191.1600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 3.389803 $173.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 21 21 18.384018 $938.5000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 67 73 29.128845 $1487.0400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 23 23 4.888507 $249.5500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.087671 $4.4800 $51.0700
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 2.603120 $132.8900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 8 11.991150 $612.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 46 50 15.769179 $805.0200 $51.0500
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.733333 $11.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.127778 $57.5700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 167 179 123.811723 $6320.6000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 30 30 8.950610 $456.9400 $51.0500
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Subtotal (Total Children Is Unduplicated) 1192 1509 1630.830745 $92762.2300 $56.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 32 35 19.735389 $98678.0000 $5000.0500
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 23 23 26.740046 $1337.0200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.211111 $15.1200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 2.718189 $625.1900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 870 1000 614.640950 $30732.3300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 45 46 19.123236 $478.1000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2501 3069 4044.039938 $202201.9200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 161 177 171.937695 $4298.4300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 844 977 1281.584884 $64079.1800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 63 91 87.243646 $2181.0800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 621 693 855.671096 $42783.5300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 31 47 45.011112 $1125.2800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1842 1965 2421.542627 $121077.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 142 152 172.517066 $4312.9300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 10.285714 $754.1500 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 3 3.666667 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 41 49 285.242858 $7131.0600 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 6 39.233333 $1961.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1225 1376 8603.607959 $430180.2300 $50.0000
INTR -T1013 INTERPRETER 147 187 605.641513 $30282.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4215 6375 30449.247587 $304492.2700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 227 246 1436.541672 $102626.4900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 22 25 146.360715 $8371.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 213 225 1116.557144 $79766.7400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 15 15 122.571430 $7006.1700 $57.1600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.733333 $83.6000 $113.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
2 2 2.090411 $953.2200 $456.0000
SENS -V5264 EARMOLD 8 8 152.628571 $2747.3100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 442 477 3252.376989 $232349.7000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 28 29 139.923809 $1942.1300 $13.8800
TRAV -TRAVS Travel by mile 1529 2774 189756.184631 $84441.5100 $0.4500
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Subtotal (Total Children Is Unduplicated) 7490 20081 245886.611321 $1869065.3700 $7.6000
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Total 21819 247940.958727 $1961857.6000 $7.9100
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Number of Children (Unduplicated) With at Least One Authorization 7898