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: 04-01-18 and 06-30-18 Date of Report: 08-10-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 41519 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 221 225 617.513486 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 5 18.676191 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 5 5 6.855554 $253.6500 $37.0000
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Subtotal (Total Children Is Unduplicated) 231 235 643.045231 $253.6500 $0.3900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 128 157 87.416679 $4239.6900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 23 24 18.891269 $970.0600 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 9 9 5.402589 $96.8100 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 521 523 522.824713 $11162.3100 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 17 17 10.113016 $127.5300 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 43 45 24.841965 $535.3400 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 36 36 18.781357 $155.1400 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.266667 $2.4200 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 37 37 20.186913 $510.9400 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 10 10 8.235464 $288.0000 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 27 27 17.147564 $1322.5900 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 0.737443 $34.2300 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 26 26 10.713929 $198.7500 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 22 22 17.338889 $358.5700 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 23 23 19.592477 $881.6600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 28 29 18.023874 $2072.7600 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 12.428571 $606.0200 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 21 26 10.355857 $517.8100 $50.0000
EXIT -EXIT EXIT ASSESSMENT 604 627 930.183486 $46509.1700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 1.700000 $127.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 45 46 59.121459 $4434.1100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 24 31 31.798477 $2384.8800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 8.027701 $602.0800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 53 75 71.058067 $5329.3600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 41 51 38.376409 $2129.9000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 645 647 1022.693906 $76702.1200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 305 305 516.022683 $38701.7600 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 133 133 196.243839 $14718.2600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 816 817 1204.906203 $66872.3200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 479 522 747.348139 $56051.1300 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 9 9 33.957143 $1697.8500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 79 81 34.376937 $1754.9300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 15 15 10.723743 $547.4500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 129 134 102.970884 $5256.6500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 434 462 194.462055 $9927.3300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 98 100 67.345195 $3437.9700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 15 15 7.516668 $383.7300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 61 66 53.821506 $2747.5900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 374 402 166.897499 $8520.1100 $51.0500
SCREEN-T1023 SCREENING 24 25 22.832115 $1141.6100 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 7 7 10.925972 $163.8900 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 9 9 4.447489 $227.0400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 26 26 17.409664 $888.7600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 764 821 462.478597 $23609.5900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 96 97 45.011950 $2297.8500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 16 16 10.470090 $466.4400 $44.5500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.068493 $2.4600 $35.9800
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.104110 $5.2100 $50.0000
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Subtotal (Total Children Is Unduplicated) 4272 6566 6897.899715 $401859.6500 $58.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 157 180 176.164134 $880820.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 12 12.566667 $628.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 70 73 54.652907 $2732.6700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.002740 $0.1900 $70.5500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 3.362329 $240.7700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 37 38 16.168114 $3718.6900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1042 1213 847.320166 $42366.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 103 107 67.989432 $1699.7400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2825 3478 4465.579469 $223278.9400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 147 159 147.119846 $3678.0100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 924 1146 1373.168137 $68658.4100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 70 122 94.455551 $2361.3800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 749 854 1046.753361 $52337.6200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 40 66 83.888888 $2097.2200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2158 2379 2501.333352 $125066.6500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 128 133 137.880960 $3447.0400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 12 13 36.168254 $2651.8700 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 20.571429 $514.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 328 443 3329.416663 $83235.4400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 3.571429 $178.5700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 8 10 67.673810 $3383.6900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7404 8356 49167.772142 $2458389.2800 $50.0000
INTR -T1013 INTERPRETER 227 259 859.800161 $42990.0200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4300 6573 30133.338368 $301333.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1329 1503 7464.837281 $533288.2100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 208 235 1339.364292 $76611.6000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1335 1492 7477.873408 $534219.5300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 69 79 603.294048 $34484.2500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 9 4.794064 $311.6200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 6 2.427625 $276.7600 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 10 10 5.326332 $1214.4200 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 4 4 2.317808 $528.4600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 16 17 14.125169 $6441.1400 $456.0000
SENS -V5264 EARMOLD 60 62 47.816399 $860.7000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2402 2696 14655.998800 $1047024.6800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 10 11 52.428571 $2998.9100 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 56 56 367.923812 $5106.7800 $13.8800
TRAV -TRAVS Travel by mile 1752 2915 182911.815751 $81395.7600 $0.4500
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Subtotal (Total Children Is Unduplicated) 10957 34718 309597.061669 $6630571.2900 $21.4200
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Total 41519 317138.006615 $7032684.5900 $22.1800
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Number of Children (Unduplicated) With at Least One Authorization 12193