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: 04-01-18 and 06-30-18 Date of Report: 08-10-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 15454 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 196 203 272.065878 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 4 8.266667 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 199 207 280.332545 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 95 112 65.824602 $3192.5000 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 10 11 14.714286 $314.1500 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.511111 $6.4500 $12.6100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.511111 $4.2200 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.511111 $12.9400 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.100000 $7.7100 $77.1300
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.863014 $99.2500 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 23 30 6.991169 $349.5800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 419 438 819.949499 $40997.4700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 5.172223 $387.9200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 0.938813 $70.4200 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 12 12 8.883335 $666.2600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 8 3.727701 $206.8900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 24.010958 $1800.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 11 11 18.008220 $1350.6200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 3.500000 $262.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 27.500000 $1526.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 14 17.012329 $1275.9200 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.877778 $43.8900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 5 1.094444 $55.8700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 30 30 14.483330 $739.3600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 7 0.572223 $29.2200 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 27 29 9.110879 $465.0900 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 3.044444 $155.4200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.211111 $10.7800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 66 71 36.887376 $1883.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 1.177778 $60.1300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 700 839 1088.188845 $56070.2800 $51.5300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 14 20.325190 $101626.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 16 16 10.809760 $540.4800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.714286 $265.9800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.988889 $227.4500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 661 769 498.378911 $24919.1400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 28 28 14.205407 $355.1400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1991 2332 3110.103206 $155505.2900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 137 145 154.200001 $3855.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 621 765 1011.850004 $50592.5300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 60 105 76.388886 $1909.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 554 637 914.072642 $45703.7100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 28 43 39.255557 $981.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1488 1611 1973.936343 $98696.8300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 119 122 130.538890 $3263.4800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 8 37.466667 $2747.0700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 19 20 70.757140 $1768.9300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 21.333333 $1066.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 244 285 1795.062705 $89753.1400 $50.0000
INTR -T1013 INTERPRETER 180 208 984.274202 $49213.6900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3310 4655 23288.992988 $232889.7700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 92 94 515.903968 $36856.1700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 19 19 107.214285 $6132.6500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 94 96 477.125795 $34085.8500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 9 9 32.933334 $1882.4700 $57.1600
RSPT -RSPT RESPITE 1 1 9.571429 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 0.174353 $11.3400 $65.0200
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.375343 $85.5700 $227.9700
SENS -V5264 EARMOLD 3 3 1.130289 $20.3500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 164 172 968.341709 $69178.3500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.642857 $93.9700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 133.999999 $1859.9200 $13.8800
TRAV -TRAVS Travel by mile 1222 2233 167493.911981 $74534.7900 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5560 14408 203898.980349 $1090622.8200 $5.3500
-------------------------------------------------------------------------------------------------------------------------------------
Total 15454 205267.501739 $1146693.1000 $5.5900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 5867