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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 39780 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 252 263 658.613797 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 6 32.614286 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 9 9 6.333335 $234.3400 $37.0000
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Subtotal (Total Children Is Unduplicated) 266 278 697.561418 $234.3400 $0.3400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 132 156 146.759820 $7117.8600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 21 21 14.304653 $734.5400 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 7 3.027779 $54.2600 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 469 479 471.415080 $10064.7100 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 20 20 10.172071 $128.2700 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 57 58 40.093440 $864.0200 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 50 50 31.696272 $261.8100 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 0.855556 $7.7500 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 49 49 29.569026 $748.3900 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 13 13 9.658449 $337.7600 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 18 18 5.780670 $445.8700 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 5 5 3.714613 $172.4300 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 27 27 8.392390 $155.6800 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 32 32 25.553807 $528.4500 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 24 25 11.709938 $526.9500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 26 28 18.810699 $2163.2400 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 5.428571 $678.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 22 26 8.814382 $440.7300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 538 565 831.011674 $41550.5900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 1.150000 $86.2500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 58 73 69.251672 $5193.8800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 32 50 29.244292 $2193.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 15 16 11.034323 $827.5800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 48 63 60.492421 $4536.9400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 72 95 84.785771 $4705.6300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 680 682 960.305446 $72023.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 275 275 435.529531 $32664.7800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 204 204 253.492365 $19011.9100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 675 676 949.722876 $52709.6400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 291 293 374.311932 $28073.3900 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 21 26 43.869838 $2193.5000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 82 83 29.870121 $1524.8600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 22 22 14.955633 $763.4900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 111 113 79.870400 $4077.3900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 411 434 181.493928 $9265.2900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 80 86 59.711147 $3048.2600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.266667 $13.6200 $51.0600
PSTH -97161 PT EVAL LOW COMPLEXITY 13 13 9.689803 $494.6600 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 50 51 32.766436 $1672.7200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 333 349 167.675046 $8559.8800 $51.0500
SCREEN-T1023 SCREENING 45 47 41.801978 $2090.1000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 7 3.236377 $48.5500 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 44.918798 $2293.1100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 13 14 15.630551 $797.9400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 726 757 465.945580 $23786.5600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 93 94 60.398838 $3083.3700 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.038356 $1.9200 $50.0600
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Subtotal (Total Children Is Unduplicated) 3980 6120 6158.229016 $352723.4200 $57.2800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 160 178 304.527823 $1522638.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 13 11.011721 $550.6000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 61 64 53.622603 $2681.1400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 1.722223 $123.3300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 42 44 22.626407 $5204.0700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1035 1232 825.449818 $41272.8200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 114 119 68.587003 $1714.6900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2672 3359 4295.235307 $214761.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 178 206 269.859888 $6746.5100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 870 1058 1288.873412 $64443.6800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 55 91 86.457138 $2161.4200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 706 792 951.846282 $47592.2700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 56 63.805555 $1595.1400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2037 2218 2522.939459 $126147.0200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 137 153 166.449210 $4161.2400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 11 11 12.580953 $922.4500 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 5.142857 $128.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 296 341 2900.617460 $72515.4500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 58.571428 $2928.5700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 12 14 60.479615 $3023.9800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7149 8045 47494.515451 $2374726.0900 $50.0000
INTR -T1013 INTERPRETER 228 281 873.437821 $43671.8900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4190 6565 29245.045657 $292450.5100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1260 1373 7006.507585 $500544.9500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 156 167 1067.140479 $61040.4000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1252 1356 6676.753986 $476987.1200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 89 93 556.450398 $31806.7000 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 8 10 5.487824 $356.7200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.114155 $127.0200 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 12 12 6.849391 $1561.6400 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
3 3 2.840640 $647.6800 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
13 14 9.825767 $4480.5600 $456.0000
SENS -V5264 EARMOLD 58 62 39.436730 $709.8700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2303 2540 14288.347244 $1020759.4900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 30.984127 $1772.3000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 51 53 574.366668 $7972.2100 $13.8800
TRAV -TRAVS Travel by mile 1742 2840 180583.130959 $80359.5000 $0.4500
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Subtotal (Total Children Is Unduplicated) 10554 33382 302433.641044 $7021287.3500 $23.2200
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Total 39780 309289.431478 $7374245.1100 $23.8400
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Number of Children (Unduplicated) With at Least One Authorization 11720