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 22921 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 216 221 241.557934 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 6 17.265078 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.922222 $34.1200 $37.0000
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Subtotal (Total Children Is Unduplicated) 223 228 259.745234 $34.1200 $0.1300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 128 147 87.300002 $4234.0600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 2.433333 $124.9500 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.219178 $21.8500 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 44 44 44.000000 $939.4000 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 5 3.641400 $45.9200 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 1.585844 $34.1700 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 6 8.863210 $73.2100 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 3.714003 $94.0000 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.222222 $42.7400 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 2.650000 $204.3900 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 1.591781 $29.5300 $18.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 0.321309 $14.4600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 1.262405 $145.1800 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 26 32 36.246040 $1812.3100 $50.0000
EXIT -EXIT EXIT ASSESSMENT 501 513 779.777904 $38988.9000 $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 10.255404 $769.1500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 17.114286 $1283.5700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.592999 $44.4800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 12 13.566666 $1017.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 18 15.373441 $853.2200 $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 23 23 29.532878 $2214.9600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 83 83 102.149317 $5669.2800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 36 37 62.170254 $4662.7700 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.900000 $45.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 12 12 4.181506 $213.4600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.178082 $9.0900 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 30 30 24.906544 $1271.4800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 84 85 49.689804 $2536.6800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 14 15 9.144552 $466.8300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 1.441400 $73.5800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 4.811567 $245.6300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 51 54 44.549760 $2274.2600 $51.0500
SCREEN-T1023 SCREENING 2 2 1.461111 $73.0600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 1.406849 $21.1000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.444444 $73.7400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 3.087671 $157.6300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 156 167 133.124899 $6796.0400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 16 16 8.024603 $409.6600 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 1177 1473 1660.324338 $88908.7700 $53.5500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 49 54 46.629529 $233148.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 7.766666 $388.3300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 20 23.529364 $1176.4600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 1.695661 $389.9900 $229.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 892 1054 690.188376 $34509.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 49 49 27.831289 $695.7900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2666 3190 4239.165039 $211958.3200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 170 180 202.950793 $5073.7700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 922 1073 1373.156533 $68657.8200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 90 132 129.871426 $3246.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 733 815 1074.007342 $53700.3500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 26 38 39.527777 $988.1900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2052 2152 2531.450230 $126572.6000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 142 144 156.690476 $3917.2600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 9.933333 $728.3100 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 0.466667 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 33 40 227.463488 $5686.6000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 6 25.980953 $1299.0500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1436 1604 10076.220635 $503810.7400 $50.0000
INTR -T1013 INTERPRETER 208 250 823.110733 $41155.5300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4533 6532 32499.654338 $324996.3500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 231 244 1456.709527 $104067.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 20 20 139.319045 $7969.0500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 212 228 1265.178614 $90384.3700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 7 71.999999 $4115.5300 $57.1600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.300000 $34.2000 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.147945 $261.7200 $227.9900
SENS -V5060 BEHIND EAR HEARING AID
2 2 3.000000 $684.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
4 4 3.255556 $1484.5500 $456.0100
SENS -V5264 EARMOLD 8 8 4.892389 $88.0600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 436 472 2909.588886 $207860.9700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 19 19 124.499998 $1728.0600 $13.8800
TRAV -TRAVS Travel by mile 1577 2865 206245.948825 $91779.4500 $0.4500
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Subtotal (Total Children Is Unduplicated) 8063 21220 266434.131432 $2132628.9900 $8.0000
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Total 22921 268354.201004 $2221571.8700 $8.2800
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Number of Children (Unduplicated) With at Least One Authorization 8499