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 21941 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 198 209 301.907933 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 2.428571 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 0.733333 $27.1300 $37.0000
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Subtotal (Total Children Is Unduplicated) 202 213 305.069837 $27.1300 $0.0900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 131 145 91.379321 $4431.8900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.022222 $1.1400 $51.3000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 71 71 69.266667 $1478.8400 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.088889 $13.7300 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.022222 $0.4800 $21.5300
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 6 3.603349 $29.7600 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 1.403349 $35.5200 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $34.9700 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 1.233334 $95.1300 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 1.314460 $24.3800 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 1.933334 $39.9800 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.526560 $23.7000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.526560 $175.5600 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 24 30 30.366588 $1518.3400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 473 483 700.963863 $35048.2100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 3.505479 $262.9100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 13 10.399848 $779.9800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 10 3.749999 $281.2400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.231888 $17.3900 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 6 6 9.061111 $679.5800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 19 14.399772 $799.1700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 68 68 97.578081 $7318.3500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 42.004110 $3150.3100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 24 24 29.626029 $2221.9500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 84 84 104.149317 $5780.2800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 36 36 56.741683 $4255.6300 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.900000 $45.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 24 26 9.198401 $469.5800 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 5 4.174049 $213.0900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 31 32 27.107762 $1383.8500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 92 96 45.961719 $2346.3400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 21 22 7.944443 $405.5600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 0.655860 $33.4800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 8 3.468494 $177.0700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 47 49 20.892074 $1066.5300 $51.0500
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 5.161644 $263.5000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 184 195 126.035347 $6434.1100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 17 17 8.072528 $412.1000 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 1229 1516 1541.670356 $82000.7400 $53.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 40 42 23.455250 $117275.0000 $4999.9500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 24 24 21.167341 $1058.3700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.294444 $21.0800 $71.6000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.184170 $272.3400 $229.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 864 998 582.962808 $29148.5500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 46 46 25.181287 $629.5400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2497 3128 4410.967791 $220548.6400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 135 150 136.911114 $3422.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 841 986 1178.534471 $58926.6600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 60 95 85.375400 $2134.3900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 676 758 948.107525 $47405.4300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 53 48.227776 $1205.6900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1857 2007 2300.798334 $115039.9300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 120 128 140.145240 $3503.6400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 5.704762 $418.2700 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 4 2.361111 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 31 35 188.749204 $4718.7300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 8.111111 $405.5600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1297 1439 8825.336079 $441266.8800 $50.0000
INTR -T1013 INTERPRETER 204 241 664.486703 $33224.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4099 6309 28532.985271 $285329.9100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 248 262 1345.102381 $96094.1200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 25 26 196.697617 $11251.1000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 224 238 1253.033329 $89516.7300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 13 14 88.714286 $5070.9100 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
3 3 1.578615 $719.8400 $456.0000
SENS -V5264 EARMOLD 8 8 12.778572 $230.0200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 469 506 2808.411901 $200632.9800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.428571 $482.1200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 48.380953 $671.5300 $13.8800
TRAV -TRAVS Travel by mile 1687 2689 175949.558815 $78297.5600 $0.4500
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Subtotal (Total Children Is Unduplicated) 7664 20212 229844.732232 $1848922.6000 $8.0400
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Total 21941 231691.472425 $1930950.4800 $8.3300
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Number of Children (Unduplicated) With at Least One Authorization 8131