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 15028 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 165 170 188.156347 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 4 12.407936 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 169 174 200.564283 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 92 104 65.949621 $3198.5600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.433333 $22.2500 $51.3500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 13 13 13.000000 $277.5500 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.900000 $11.3500 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.927777 $19.9900 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.900000 $7.4300 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.900000 $22.7800 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.055556 $4.2900 $77.1900
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.162405 $7.3100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.955556 $109.8900 $115.0100
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 25 31 34.246040 $1712.3100 $50.0000
EXIT -EXIT EXIT ASSESSMENT 350 361 549.870252 $27493.5200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 0.967961 $72.5900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 13.425397 $1006.9100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.588889 $44.1700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 7 5.977778 $448.3400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 8 6.142999 $340.9400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 23.510958 $1763.3300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 2.005479 $150.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 23.010958 $1277.1100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 7 13.500000 $1012.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 5 1.588889 $81.1100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.178082 $9.0900 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 6.373288 $325.3600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 39 40 21.366548 $1090.7800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 6 2.754871 $140.6400 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.219178 $11.1900 $51.0600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.606088 $30.9400 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 28 29 30.970397 $1581.0400 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.106849 $1.6000 $14.9900
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 57 61 31.533869 $1609.8200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 9 9 2.955556 $150.8800 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 630 754 867.384574 $44828.0600 $51.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 19 18.844978 $94225.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 5.866666 $293.3300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 14 14 19.483333 $974.1700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.140182 $32.2200 $229.8700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 631 745 485.063771 $24253.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 35 35 18.770289 $469.2600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1977 2343 3044.348444 $152217.4200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 127 135 149.165872 $3729.1500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 655 774 965.905739 $48295.2800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 63 94 93.182537 $2329.5600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 524 576 750.363766 $37518.1700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 20 16.750001 $418.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1445 1503 1696.944014 $84847.2300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 108 110 113.681743 $2842.0400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.133333 $83.0900 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 0.466667 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 18.000000 $450.0000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 5 19.847620 $992.3900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 198 215 1381.388086 $69069.4100 $50.0000
INTR -T1013 INTERPRETER 187 227 697.639305 $34881.9500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3328 4739 23441.412375 $234413.9900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 87 91 558.533332 $39901.6500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 12 12 77.697618 $4444.3000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 73 78 443.478569 $31682.1000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 15.000000 $857.4000 $57.1600
SENS -V5060 BEHIND EAR HEARING AID
1 1 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
3 3 1.955556 $891.7500 $456.0100
SENS -V5264 EARMOLD 3 3 1.388889 $25.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 155 166 1041.223016 $74384.9300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 39.714284 $551.2300 $13.8800
TRAV -TRAVS Travel by mile 1201 2176 166130.511056 $73928.0800 $0.4500
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Subtotal (Total Children Is Unduplicated) 5463 14100 201249.901041 $1019458.3000 $5.0700
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Total 15028 202317.849898 $1064286.3600 $5.2600
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Number of Children (Unduplicated) With at Least One Authorization 5749