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
Eligibility Filter: Program Patients
With the filters selected there were 39610 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 226 231 249.157936 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 6 17.265078 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 7 7 8.944444 $330.9400 $37.0000
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Subtotal (Total Children Is Unduplicated) 239 244 275.367458 $330.9400 $1.2000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 145 167 97.238965 $4716.0800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 19 20 15.000000 $770.2500 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 3.702511 $66.3500 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 467 470 467.874658 $9989.1200 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 22 22 19.059349 $240.3400 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 47 48 21.713624 $467.9300 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 37 38 30.220363 $249.6200 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.450000 $4.0800 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 37 38 25.991704 $657.8400 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 8 8 7.672222 $268.3000 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 16 16 8.127778 $626.9000 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 28 29 17.647564 $327.3600 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 9 7.894444 $163.2600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 17 19 11.925093 $536.6300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 22 22 11.636836 $1338.2600 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 34 43 40.018110 $2000.9200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 513 525 803.492190 $40174.6100 $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 61 66 86.227091 $6467.0400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 27 34 70.331287 $5274.8600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 13.609589 $1020.7200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 49 64 74.864537 $5614.8200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 58 64 70.426712 $3908.6700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 694 696 1114.935791 $83620.2800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 307 307 517.899613 $38842.5200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 153 153 234.345312 $17575.9000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 736 737 1128.155149 $62612.6300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 329 344 524.553134 $39341.4800 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.566667 $128.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 13 36.777776 $1838.9000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 59 62 16.436073 $839.0600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 8 8 5.572526 $284.4800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 129 132 103.376637 $5277.3800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 410 426 192.105334 $9807.0100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 62 64 22.774003 $1162.6100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 14 14 7.896956 $403.1400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 49 49 42.583226 $2173.8700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 331 350 169.151378 $8635.1500 $51.0500
SCREEN-T1023 SCREENING 31 32 27.035692 $1351.7900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 5 1.628767 $24.4300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 8 8 5.333332 $272.2600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 23 23 26.186583 $1336.8300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 663 698 462.644543 $23618.0000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 107 109 50.962047 $2601.6300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 3.422222 $152.4600 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.183333 $59.1700 $50.0000
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Subtotal (Total Children Is Unduplicated) 3859 5964 6612.156200 $387606.1700 $58.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 169 192 136.066213 $680332.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 8 9 11.433333 $571.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 51 55 53.681224 $2684.0600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 1.963851 $140.6300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 31 33 17.036758 $3918.4600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1032 1227 850.472835 $42524.0800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 97 97 64.052679 $1601.3200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2704 3230 4279.026944 $213951.4300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 171 181 203.073015 $5076.8200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 946 1098 1388.206534 $69410.3200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 91 133 129.954759 $3248.8600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 751 833 1085.843340 $54292.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 26 38 39.527777 $988.1900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2082 2184 2551.885946 $127594.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 144 146 158.101587 $3952.5400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 25 26 61.746823 $4527.2900 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 0.466667 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 234 257 2694.177772 $67354.4400 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 10 10 29.047620 $1452.3900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7463 8164 50407.707497 $2520384.0000 $50.0000
INTR -T1013 INTERPRETER 209 252 832.396447 $41619.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4533 6535 32506.321005 $325063.0100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1264 1356 7414.838090 $529716.0300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 181 195 1154.561902 $66040.9300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1363 1487 7903.495973 $564625.6500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 66 69 391.740472 $22391.9000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 0.610959 $39.7200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 4 5 3.064384 $349.3400 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 8 9 3.364839 $767.1700 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
7 7 9.100000 $2074.8000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
16 18 17.372147 $7921.7200 $456.0000
SENS -V5264 EARMOLD 49 52 43.318178 $779.7300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2335 2556 14867.626671 $1062142.9500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 13.142857 $751.7700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 71 71 442.930156 $6147.8700 $13.8800
TRAV -TRAVS Travel by mile 1577 2866 206248.805968 $91780.7200 $0.4500
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Subtotal (Total Children Is Unduplicated) 10712 33402 336016.163222 $6526218.6600 $19.4200
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Total 39610 342903.686880 $6914155.7800 $20.1600
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Number of Children (Unduplicated) With at Least One Authorization 11377