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: 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 38249 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 196 199 450.227294 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 26.361905 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 6.300000 $233.1000 $37.0000
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Subtotal (Total Children Is Unduplicated) 207 210 482.889199 $233.1000 $0.4800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 126 145 89.153405 $4323.9500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 15 15 10.344444 $531.1900 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 8 3.472527 $62.2300 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 498 503 496.055556 $10590.7900 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 16 12.022353 $151.6000 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 38 42 22.288734 $480.3200 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 39 41 25.066883 $207.0500 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 0.872222 $7.9000 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 36 38 24.540073 $621.1000 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 9 10 7.094445 $248.0900 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 26 27 19.077777 $1471.4600 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 2.614612 $121.3700 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 27 29 12.872515 $238.7800 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 23 24 19.541097 $404.1100 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 23 26 23.023482 $1036.0500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 30 33 27.449054 $3156.6500 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 21 25 9.876102 $493.8200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 499 515 828.180863 $41409.0600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.711111 $53.3300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 46 51 56.682265 $4251.1700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 24 33 28.527623 $2139.5600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 12.131583 $909.8800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 44 52 45.452739 $3408.9600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 61 73 79.957990 $4437.6700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 678 680 958.261610 $71869.7200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 273 273 431.529531 $32364.7800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 206 206 256.118392 $19208.8600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 676 679 929.412895 $51582.4400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 292 295 376.228143 $28217.1200 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 13 15 37.833331 $1891.6800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 78 82 29.624605 $1512.3500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 6.443227 $328.9300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 113 115 81.659894 $4168.7400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 414 435 187.727231 $9583.5100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 90 93 32.695766 $1669.1100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 8 8 5.483334 $279.9300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 47 48 34.874275 $1780.3200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 337 357 192.965786 $9850.9300 $51.0500
SCREEN-T1023 SCREENING 37 38 33.938660 $1696.9300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 6 1.256164 $18.8400 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 14 14 9.910274 $505.9200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 16 17 9.060959 $462.5600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 677 714 381.267463 $19463.7100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 128 128 51.884171 $2648.6900 $51.0500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.186301 $6.7000 $35.9800
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.147945 $7.4000 $49.9800
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Subtotal (Total Children Is Unduplicated) 3786 5939 5905.519412 $339875.2400 $57.5500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 144 161 124.691271 $623456.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 11 7.125723 $356.2900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 63 66 69.116929 $3455.8400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 8 8 15.886052 $1137.6000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 34 37 15.503347 $3565.7600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1038 1210 936.966070 $46848.6700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 108 110 59.173532 $1479.3500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2736 3286 4939.991350 $246999.4800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 149 164 191.969049 $4799.2300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 842 965 1336.449831 $66822.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 59 95 95.688892 $2392.2300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 683 747 1036.616987 $51830.8000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 40 61 67.700003 $1692.5100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2067 2176 2608.478100 $130423.8700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 132 135 180.183333 $4504.5800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 7 23.869841 $1750.1300 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 47.428571 $1185.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 279 295 2793.100023 $69827.4800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 53.571429 $2678.5700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 7 8 45.759523 $2287.9800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7246 7923 52846.499885 $2642323.3800 $50.0000
INTR -T1013 INTERPRETER 214 276 948.103412 $47405.1800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4192 6185 30894.483618 $308944.6200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1251 1340 7643.352825 $546040.8200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 152 159 957.134521 $54748.1200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1239 1319 7589.731645 $542210.2400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 65 69 362.585715 $20725.4000 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 11 6.271004 $407.6200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.422070 $162.1100 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 7 8 2.130745 $485.8200 $228.0100
SENS -V5060 BEHIND EAR HEARING AID
2 2 1.145205 $261.1100 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
12 14 17.176299 $7832.3900 $456.0000
SENS -V5264 EARMOLD 45 50 42.796657 $770.3500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2243 2403 14858.655247 $1061501.9400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 43.500000 $2488.2000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 54 55 387.595241 $5379.8200 $13.8800
TRAV -TRAVS Travel by mile 1502 2732 177401.490175 $78943.6700 $0.4500
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Subtotal (Total Children Is Unduplicated) 10352 32100 308654.344120 $6588125.8500 $21.3400
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Total 38249 315042.752731 $6928234.1900 $21.9900
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Number of Children (Unduplicated) With at Least One Authorization 10960