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 23921 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 209 213 599.591265 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 5 18.676191 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 214 218 618.267456 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 113 141 82.089662 $3981.3300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 7.785714 $399.8000 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 3.447033 $61.7700 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 78 80 84.947619 $1813.6300 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 3.947033 $49.7700 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 7 4.327931 $93.2700 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 8 8 5.862101 $48.4200 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 8 8 5.862101 $148.3700 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 3.279908 $114.7000 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 5.194445 $400.6500 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.104110 $4.8300 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 2.466211 $45.7500 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 7.177777 $148.4300 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.694445 $76.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 3.175114 $365.1500 $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 19 24 9.868947 $493.4700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 588 610 903.964308 $45198.2100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.200000 $15.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 3.055556 $229.1700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 3.205479 $240.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.022222 $1.6700 $74.9300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 12 13 10.722222 $804.1700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 15 15 6.519178 $361.8100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 89 89 105.752048 $7931.4200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 30 30 44.035615 $3302.6800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 33 33 27.701371 $2077.6000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 140 140 166.986303 $9267.7300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 58 63 75.130135 $5634.7700 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 28 28 8.127777 $414.9200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 1.485768 $75.8500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 24 24 25.157947 $1284.3100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 80 86 46.729330 $2385.5200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 36 36 24.566667 $1254.1300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 2.094445 $106.9200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 6.813471 $347.8300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 64 70 26.896987 $1373.0800 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 1.358067 $20.3700 $15.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 1.661111 $84.8000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 184 193 110.927294 $5662.8700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 12 12 4.877777 $249.0100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.411111 $62.8600 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.104110 $5.2100 $50.0000
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Subtotal (Total Children Is Unduplicated) 1422 1798 1854.165021 $97368.9100 $52.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 45 50 52.438659 $262192.5000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 6.400000 $320.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 31 33 19.912995 $995.6600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 0.806089 $185.4000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 892 1040 681.713573 $34085.9000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 47 47 23.313628 $582.8400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2784 3436 4434.380338 $221718.9700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 146 158 146.762703 $3669.0800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 893 1113 1354.639567 $67731.9800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 69 121 94.255551 $2356.3800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 720 824 1026.438280 $51321.8500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 40 66 83.888888 $2097.2200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2108 2326 2468.805654 $123440.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 128 133 137.880960 $3447.0400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 6 18.017461 $1321.0500 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 51 62 365.366667 $9134.1700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 7 30.333334 $1516.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1443 1609 9582.804757 $479140.2300 $50.0000
INTR -T1013 INTERPRETER 218 249 836.800161 $41840.0200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4299 6572 30129.052654 $301290.5800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 247 269 1516.540465 $108341.6900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 25 29 178.128572 $10188.9400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 255 271 1451.224957 $103675.5400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 12 13 132.540476 $7576.0200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 3.325419 $216.1600 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.358067 $40.8200 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.391780 $89.3300 $228.0100
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.175342 $495.9700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 4 2.327778 $1061.4800 $456.0000
SENS -V5264 EARMOLD 10 10 4.575114 $82.3500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 461 507 2950.369838 $210774.3800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.571429 $375.8800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 15 15 175.142859 $2430.9800 $13.8800
TRAV -TRAVS Travel by mile 1751 2914 182907.530037 $81393.8500 $0.4500
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Subtotal (Total Children Is Unduplicated) 8233 21905 240826.214052 $2135202.8100 $8.8700
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Total 23921 243298.646529 $2232571.7200 $9.1800
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Number of Children (Unduplicated) With at Least One Authorization 8744