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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 15222 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 256 261 461.712883 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 4 20.476190 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 259 265 482.189073 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 101 116 67.967708 $3296.4300 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 13 13 13.000000 $305.3700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.500000 $6.9400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.405556 $9.6100 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.500000 $4.5400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.500000 $13.9200 $27.8300
EVAL -96111 DEVELOPMENTAL EVALUATION 25 34 35.849846 $1792.4900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 370 380 620.021702 $31001.0900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 10.394445 $779.5900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 11 11 3.266667 $245.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 12 12 10.638890 $797.9300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 11 5.605556 $311.1100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 12.005479 $900.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 16 16 26.291193 $1459.1600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 18.785714 $1408.9300 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 9 9 3.261110 $166.4700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 4.316667 $220.3700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 25 25 9.008143 $459.8600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 4 1.494444 $76.2900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.694445 $35.4500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 31 31 13.937672 $711.5200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.411111 $20.9900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.027778 $1.4200 $51.0900
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 47 48 27.648423 $1411.4400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.433333 $21.2100 $48.9400
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Subtotal (Total Children Is Unduplicated) 634 758 894.965882 $46057.5300 $51.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 17 18 28.693738 $143469.0000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 19 25.614145 $1280.7100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.142857 $225.0600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.044444 $10.2100 $229.7700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 591 722 453.240871 $22662.2500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 29 31 19.518103 $487.9500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1885 2201 2777.757799 $138887.8100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 151 171 153.135712 $3828.3900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 630 777 933.535334 $46676.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 68 119 90.494440 $2262.3500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 534 585 652.921888 $32646.1200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 27 43 47.788888 $1194.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1441 1540 1612.703909 $80635.1400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 125 136 124.371424 $3109.2700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 9.490476 $695.8400 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 8 61.301585 $1532.5400 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 15.133333 $756.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 242 257 1470.364287 $73518.2000 $50.0000
INTR -T1013 INTERPRETER 191 208 709.161815 $35458.1200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3413 4794 23148.069249 $231480.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 78 81 414.219052 $29591.8000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 20 20 138.464287 $7920.1500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 92 94 474.374601 $33889.3100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 9 9 75.714287 $4327.8300 $57.1600
RSPT -RSPT RESPITE 1 1 3.571429 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 0.335769 $21.8300 $65.0100
SENS -V5264 EARMOLD 2 2 0.516438 $9.3000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 148 155 857.553464 $61263.6100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 7.571429 $105.0900 $13.8800
TRAV -TRAVS Travel by mile 1386 2194 148054.583400 $65884.2900 $0.4500
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Subtotal (Total Children Is Unduplicated) 5743 14199 182363.388453 $1023830.9100 $5.6100
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Total 15222 183740.543408 $1069888.4400 $5.8200
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Number of Children (Unduplicated) With at Least One Authorization 6072