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 23547 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 252 259 342.511114 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 5 12.980953 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 256 264 355.492067 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 141 162 100.658209 $4881.9200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 6 7.041270 $361.5700 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 1.381051 $24.7500 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 63 65 67.930953 $1450.3300 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 2.675495 $33.7400 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 3.253273 $70.1100 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 9 6.892162 $56.9300 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 8 8 5.892162 $149.1300 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $69.9400 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 0.977778 $75.4200 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $46.4200 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 3.164384 $58.7000 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 6.166667 $127.5300 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 1.488889 $67.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 1.749924 $201.2400 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 24 32 7.318947 $365.9700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 569 598 1048.616623 $52430.8100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 11.172223 $837.9200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 10 10 1.244369 $93.3400 $75.0100
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.088889 $6.6700 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 17 18 18.138891 $1360.4300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 14 14 5.891400 $326.9700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 87 87 104.652048 $7848.9200 $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 31 31 25.575344 $1918.1500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 138 138 320.986303 $17814.7300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 58 63 75.130135 $5634.7700 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.877778 $43.8900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 13 13 2.455554 $125.3500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.156164 $110.0700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 18 19 20.835573 $1063.6600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 72 75 54.046484 $2759.0500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 14 14 2.233105 $114.0000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 8 4.435540 $226.4300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 58 65 34.154551 $1743.5700 $51.0500
SCREEN-T1023 SCREENING 3 3 2.511111 $125.5600 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 3.044444 $155.4200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.211111 $61.8300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 147 158 86.546793 $4418.2100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 5 5 3.177778 $162.2300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 3.082192 $137.3100 $44.5500
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Subtotal (Total Children Is Unduplicated) 1331 1689 2095.891182 $110862.6300 $52.9000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 46 54 53.850380 $269251.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.544444 $27.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 22 23 18.165317 $908.2600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.714286 $265.9800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 4.199240 $965.8400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 902 1044 690.874766 $34543.9800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 43 43 21.083073 $527.0800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2687 3171 4338.744033 $216937.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 160 170 175.005558 $4375.1500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 927 1123 1518.536510 $75926.8700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 72 121 86.294440 $2157.3500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 758 866 1260.306954 $63015.4100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 37 59 54.827780 $1370.7000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2106 2285 2832.481849 $141624.0900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 138 142 153.335715 $3833.4000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 11 40.016667 $2934.0300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 64 77 348.167458 $8704.1800 $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 1481 1667 10694.749997 $534737.3800 $50.0000
INTR -T1013 INTERPRETER 209 241 1117.408253 $55870.4000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4493 6399 32075.092163 $320750.7400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 233 246 1391.975403 $99442.6900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 26 26 140.621427 $8043.5500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 235 246 1309.035320 $93517.4300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 14 15 63.826190 $3648.3100 $57.1600
RSPT -RSPT RESPITE 1 1 9.571429 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 0.707686 $46.0000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 0.517809 $118.0600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 3.288889 $1499.7400 $456.0000
SENS -V5264 EARMOLD 11 12 6.703578 $120.6700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 455 485 2918.329799 $208485.4800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 22.714285 $1299.2600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 25 25 311.785712 $4327.5900 $13.8800
TRAV -TRAVS Travel by mile 1630 3017 207348.397500 $92270.0400 $0.4500
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Subtotal (Total Children Is Unduplicated) 8246 21594 269036.207243 $2252612.3300 $8.3700
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Total 23547 271487.590492 $2363474.9600 $8.7100
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Number of Children (Unduplicated) With at Least One Authorization 8736