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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 27618 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 168 173 193.056348 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 4 12.407936 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 5 5 7.688889 $284.4900 $37.0000
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Subtotal (Total Children Is Unduplicated) 177 182 213.153173 $284.4900 $1.3300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 98 110 69.424887 $3367.1100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 13 13 9.922222 $509.5100 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.033333 $18.5200 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 314 315 313.424658 $6691.6200 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 12 12 11.656838 $146.9900 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 30 30 11.111112 $239.4500 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 19 19 12.833028 $106.0000 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 21 21 14.833028 $375.4200 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $69.9400 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 12 12 4.533334 $349.6600 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 14 14 8.711110 $161.5900 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 4.444444 $91.9100 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 8 4.061797 $182.7800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 13 6.821158 $784.4500 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 27 33 34.568263 $1728.4200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 352 363 553.870252 $27693.5200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 41 44 57.511946 $4313.4000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 21 25 60.886842 $4566.5300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 13.605479 $1020.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 34 41 46.084171 $3456.3100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 41 45 47.768569 $2651.1500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 498 500 798.511727 $59888.4700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 247 247 409.593352 $30719.5500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 101 101 150.812434 $11310.9400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 559 560 857.000353 $47563.5500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 257 268 398.858222 $29914.3600 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 5 14.390476 $719.5300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 37 39 8.953349 $457.0800 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 2.350304 $119.9800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 77 78 58.096044 $2965.8000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 252 265 111.924848 $5713.7900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 36 37 11.512102 $587.7000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 10 10 6.113623 $312.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 31 31 21.726485 $1109.1300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 224 239 120.729159 $6163.2100 $51.0500
SCREEN-T1023 SCREENING 23 24 19.396803 $969.8400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.106849 $1.6000 $14.9900
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 4.888888 $249.5700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 10 10 9.115068 $465.3300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 368 387 232.430203 $11865.5500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 67 69 29.945814 $1528.7400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $133.6500 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 2608 4027 4565.862574 $271849.1300 $59.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 102 116 79.313929 $396571.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 7.122222 $356.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 23 24 25.833333 $1291.6700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.777778 $55.7000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 10 11 4.383333 $1008.1600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 714 844 591.587808 $29579.6900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 68 68 45.944797 $1148.6200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2003 2370 3075.169079 $153758.4600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 127 135 149.165872 $3729.1500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 669 788 972.689073 $48634.4500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 63 94 93.182537 $2329.5600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 538 590 760.810875 $38040.5300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 20 16.750001 $418.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1461 1520 1708.529729 $85426.5300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 110 112 115.092854 $2877.3200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 19 20 47.633331 $3492.4900 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 0.466667 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 177 188 1985.999997 $49649.9900 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 8 8 22.714287 $1135.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5489 5974 37187.118586 $1859355.0100 $50.0000
INTR -T1013 INTERPRETER 188 229 706.925019 $35346.2400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3328 4740 23442.079042 $234420.6500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 774 829 4459.384509 $318578.4100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 130 140 864.292859 $49437.5400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 871 938 5017.982446 $358484.5700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 46 49 275.249998 $15733.3000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.010959 $0.7200 $65.2400
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 1.583561 $361.0600 $228.0100
SENS -V5060 BEHIND EAR HEARING AID
3 3 5.000000 $1140.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
5 6 3.894369 $1775.8500 $456.0000
SENS -V5264 EARMOLD 25 26 15.490869 $278.8400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1225 1339 7612.996504 $543872.3300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 8.571428 $490.2800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 38 38 258.657142 $3590.1600 $13.8800
TRAV -TRAVS Travel by mile 1201 2176 166130.511056 $73928.0800 $0.4500
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Subtotal (Total Children Is Unduplicated) 7420 23409 255692.915849 $4316296.8800 $16.8800
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Total 27618 260471.931596 $4588430.5000 $17.6200
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Number of Children (Unduplicated) With at Least One Authorization 7880