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
Eligibility Filter: Program Patients
With the filters selected there were 40787 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 254 261 351.168257 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 5 12.980953 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 2.411111 $89.2100 $37.0000
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Subtotal (Total Children Is Unduplicated) 261 269 366.560321 $89.2100 $0.2400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 159 184 111.853719 $5424.9000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 19 22 21.720135 $1115.3300 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 6 6 5.247717 $94.0400 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 498 504 518.642064 $11073.0100 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 23 24 17.186607 $216.7200 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 51 52 32.667351 $703.9800 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 46 46 45.263177 $373.8700 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 47 48 49.414014 $1250.6700 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 7 8 9.866666 $345.0400 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 19 20 13.695283 $1056.3300 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 1.139726 $52.9000 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 37 37 28.961915 $537.2400 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 16 17 22.217504 $459.4600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 21 22 22.146305 $996.5900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 28 30 28.599195 $3288.9100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 25 33 7.413391 $370.6900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 582 612 1069.835801 $53491.7700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 50 58 77.938128 $5845.3800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 23 32 24.448479 $1833.6500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 6.094368 $457.0800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 64 93 94.896960 $7117.3100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 37 46 33.676407 $1869.0300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 645 646 1027.360573 $77052.1200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 307 307 520.022683 $39001.7600 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 130 130 192.617812 $14446.3100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 811 812 1347.477631 $74785.0300 $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 11.714286 $585.7200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 7 26.592064 $1329.6000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 65 66 18.694445 $954.3500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 16 17 15.544824 $793.5600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 106 113 94.313676 $4814.7200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 382 404 233.744372 $11932.6100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 51 55 12.741271 $650.4500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 9 9 9.079137 $463.4900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 57 59 44.263948 $2259.6800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 348 379 200.800361 $10250.8200 $51.0500
SCREEN-T1023 SCREENING 46 47 38.682954 $1934.1600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 0.984431 $14.7700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 10 10 5.894444 $300.9100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 29 29 21.864764 $1116.2000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 627 691 387.513648 $19782.5900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 50 50 34.867588 $1779.9800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 29 29 25.689714 $1144.4800 $44.5500
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Subtotal (Total Children Is Unduplicated) 3943 6288 7262.237677 $419530.8100 $57.7700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 169 191 151.569363 $757848.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 12 10.722223 $536.1200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 59 62 57.471089 $2873.5400 $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 7.369843 $527.7700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 40 40 24.547977 $5646.0400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1050 1211 853.509485 $42675.7500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 96 102 68.821662 $1720.5500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2725 3211 4378.974910 $218948.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 160 170 175.005558 $4375.1500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 941 1140 1533.251590 $76662.6300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 72 121 86.294440 $2157.3500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 787 896 1284.263304 $64213.2300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 37 59 54.827780 $1370.7000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2134 2316 2858.263517 $142913.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 138 142 153.335715 $3833.4000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 16 18 50.738889 $3720.1800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 308 409 2225.396800 $55634.9000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 61.428571 $3071.4300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 7 7 60.014285 $3000.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7735 8517 54102.950139 $2705146.1500 $50.0000
INTR -T1013 INTERPRETER 218 251 1143.836825 $57191.8200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4494 6401 32078.301687 $320782.8300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1331 1472 7636.809940 $545573.6500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 198 219 1157.507140 $66209.3900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1334 1473 7778.498810 $555695.8000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 81 85 710.684126 $40622.7000 $57.1600
RSPT -RSPT RESPITE 2 2 13.428572 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 7 1.829756 $118.9400 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.349771 $153.8700 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 8 8 6.654795 $1517.2900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 4 4 3.607306 $822.4600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 18 18 21.039683 $9594.1500 $456.0000
SENS -V5264 EARMOLD 58 60 64.633846 $1163.4100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2267 2494 14360.661961 $1025925.6700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 11 12 58.642858 $3354.3800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 70 71 573.596033 $7961.5100 $13.8800
TRAV -TRAVS Travel by mile 1631 3018 207350.464167 $92270.9600 $0.4500
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Subtotal (Total Children Is Unduplicated) 11009 34230 341160.307156 $6825834.6500 $20.0100
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Total 40787 348789.105154 $7245454.6700 $20.7700
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Number of Children (Unduplicated) With at Least One Authorization 11712