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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 38065 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 203 216 308.430156 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 2.428571 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 9 9 5.733333 $212.1300 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 214 227 316.592060 $212.1300 $0.6700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 156 172 100.053597 $4852.5900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 7.458731 $383.0100 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 2.988889 $53.5600 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 459 461 465.188889 $9931.7800 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 14 12.711709 $160.2900 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 46 46 49.335713 $1063.1800 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 38 39 26.262437 $216.9300 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.372222 $3.3700 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 39 40 31.764329 $803.9600 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 6 5.372222 $187.8700 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 16 16 9.255556 $713.8800 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 8.285714 $384.6200 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 25 26 17.420048 $323.1400 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 12 12 7.338890 $151.7700 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 22 23 17.814948 $801.6800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 36 38 23.267960 $2675.8100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 31 40 34.288658 $1714.4500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 479 489 714.678149 $35733.9300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 6 8.505479 $637.9100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 66 73 93.549312 $7016.2000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 32 42 32.727318 $2454.5600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 13.248478 $993.6400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 49 61 75.781205 $5683.5800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 59 66 64.175266 $3561.7100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 693 694 1115.852305 $83689.0300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 308 308 540.849907 $40563.8000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 153 153 233.750791 $17531.3200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 737 738 1130.655149 $62751.3800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 329 343 519.624563 $38971.8400 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 13 16 36.242858 $1812.1400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 73 78 20.130440 $1027.6600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 14 15 10.943075 $558.6500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 110 115 87.519559 $4467.8700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 420 449 184.620862 $9424.9100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 88 92 47.613771 $2430.6700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 14 14 7.164460 $365.7500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 39 41 27.018723 $1379.3000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 303 320 116.676084 $5956.3200 $51.0500
SCREEN-T1023 SCREENING 33 35 32.540641 $1627.0400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 4 2.188585 $32.8300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 10 10 9.142466 $466.7200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 16 16 21.835475 $1114.7100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 706 742 407.212305 $20788.1800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 91 93 44.038271 $2248.1400 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 1.000000 $50.0000 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3943 5972 6418.466009 $377761.6700 $58.8600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 172 187 114.680921 $573403.0000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 7 3.401978 $170.1000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 73 76 60.618984 $3030.9600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 10 10 14.526549 $1040.2400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 42 43 27.024046 $6215.4500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 987 1153 726.987379 $36349.8100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 91 91 59.322312 $1483.0600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2534 3167 4446.432871 $222321.9100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 137 152 137.461907 $3436.5600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 861 1006 1190.216217 $59510.7500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 61 96 85.458733 $2136.4800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 691 773 959.096414 $47954.8700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 53 48.227776 $1205.6900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1906 2057 2337.830078 $116891.5200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 121 129 141.145240 $3528.6400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 8 20.926985 $1534.3700 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 4 2.361111 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 250 279 2485.120634 $62128.0200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 11.142857 $557.1500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 6 12.344444 $617.2200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6815 7622 46085.443352 $2304272.8000 $50.0000
INTR -T1013 INTERPRETER 205 243 673.915275 $33695.7500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4099 6311 28537.361461 $285373.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1274 1394 6811.987766 $486648.5200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 155 164 909.617858 $52030.1000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1262 1388 6662.992252 $476004.4400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 63 67 394.783336 $22565.8000 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 2.760730 $179.4500 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 4 4 2.564384 $292.3400 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 14 15 4.705783 $1072.9000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
4 4 2.295890 $523.4700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
19 20 14.599772 $6657.5100 $456.0000
SENS -V5264 EARMOLD 63 68 53.271341 $958.8900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2290 2524 13581.099158 $970233.9900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 16.285714 $931.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 40 42 281.552381 $3907.9500 $13.8800
TRAV -TRAVS Travel by mile 1687 2690 175950.792148 $78298.1000 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 10228 31866 292871.356037 $5867162.9500 $20.0300
-------------------------------------------------------------------------------------------------------------------------------------
Total 38065 299606.414106 $6245136.7500 $20.8400
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 11396