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 23212 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 246 257 655.147130 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 6 32.614286 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 251 263 687.761416 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 106 129 136.181053 $6604.7900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 3.993651 $205.0700 $51.3500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 81 84 82.411112 $1759.4800 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.180822 $2.2800 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 1.205480 $25.9800 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 9 5.546728 $45.8200 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 2.380061 $60.2400 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.191781 $6.7100 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 1.547337 $119.3500 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.166667 $54.1600 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 1.380061 $25.6000 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 3.669711 $75.8900 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 0.864308 $38.9000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.257839 $144.6600 $115.0100
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 5.428571 $678.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 19 23 7.644518 $382.2400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 529 556 815.011674 $40750.5900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.383333 $28.7500 $74.9900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 20 20 14.320624 $1074.0500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 17 17 3.600001 $270.0100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 2.316514 $173.7500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 19 19 10.535921 $790.1900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 30 31 17.667961 $980.5800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 76 76 60.200001 $4514.9900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 25 25 32.542463 $2440.7000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 46 46 41.097263 $3082.2800 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 109 109 91.247943 $5064.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 56 56 63.802737 $4785.2200 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 26 27 9.361903 $477.9200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 0.648022 $33.0900 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 23 23 21.750000 $1110.3400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 81 88 31.555622 $1610.9300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 31 31 14.892063 $760.2400 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 1.844445 $94.1600 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 11 6.070852 $309.9100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 63 65 35.154210 $1794.6400 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.533333 $23.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.844444 $43.1100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 182 188 109.854993 $5608.1100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 32 32 24.362940 $1243.7400 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.038356 $1.9200 $50.0600
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Subtotal (Total Children Is Unduplicated) 1338 1723 1668.687318 $87448.2700 $52.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 40 43 150.261264 $751306.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 2.655556 $132.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 16 17 6.594444 $329.7200 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 6.100000 $1403.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 863 1021 618.354049 $30918.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 36 38 18.609457 $465.2400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2634 3314 4255.933720 $212796.7000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 178 206 269.859888 $6746.5100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 856 1043 1280.863889 $64043.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 55 91 86.457138 $2161.4200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 677 760 920.885193 $46044.2200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 56 63.805555 $1595.1400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2003 2183 2489.472791 $124473.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 137 153 166.449210 $4161.2400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 4.352381 $319.1200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 41 47 235.882538 $5897.0700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 9 11 55.900000 $2795.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1315 1488 8595.541863 $429777.1900 $50.0000
INTR -T1013 INTERPRETER 215 267 797.487028 $39874.3500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4189 6563 29240.559943 $292405.6600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 231 245 1370.894839 $97936.7400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 24 26 173.071430 $9899.6800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 237 248 1344.463493 $96048.4200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 23 24 162.785714 $9304.8400 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 0.898326 $58.4000 $65.0100
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.533333 $60.8000 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.035616 $8.1200 $227.9000
SENS -V5060 BEHIND EAR HEARING AID
1 1 1.166667 $266.0100 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
3 3 1.255556 $572.5500 $456.0200
SENS -V5264 EARMOLD 8 8 2.938204 $52.8900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 451 488 3034.854758 $216810.0200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 19.984127 $1143.1000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 17 18 296.714289 $4118.3900 $13.8800
TRAV -TRAVS Travel by mile 1741 2838 180578.645245 $80357.5000 $0.4500
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Subtotal (Total Children Is Unduplicated) 7896 21226 236255.267504 $2534283.1800 $10.7300
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Total 23212 238611.716238 $2621731.4500 $10.9900
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Number of Children (Unduplicated) With at Least One Authorization 8391