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
Eligibility Filter: Program Patients
With the filters selected there were 40032 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 335 341 566.091456 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 7 24.409523 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 6 6 6.355556 $235.1600 $37.0000
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Subtotal (Total Children Is Unduplicated) 346 354 596.856535 $235.1600 $0.3900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 164 191 114.807585 $5568.1800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 15 15 13.666960 $772.0400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 3.450000 $68.0000 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 475 479 488.044445 $11464.1700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 22 22 13.088889 $181.5400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 45 45 27.853056 $660.1200 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 33 33 46.037553 $418.0200 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 41 41 52.287173 $1455.1600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 6 6.255556 $240.6500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 16 16 8.551370 $725.5000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 1.945814 $99.3700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 23 23 20.696631 $345.6400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 16 17 13.603351 $304.7200 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 20 21 20.671757 $930.2300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 24 24 26.353643 $3030.6600 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 34 44 45.716512 $2285.8200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 531 553 865.911501 $43295.5800 $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 48 60 75.205556 $5640.4200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 38 51 45.477701 $3410.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 9 6.047185 $453.5400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 45 60 78.935541 $5920.1700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 43 57 57.184703 $3173.7600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 510 512 913.729181 $68529.7200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 290 293 535.815648 $40186.2000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 72 72 120.054793 $9004.1200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 727 728 1085.157323 $60226.2600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 586 661 989.221323 $74191.6300 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.285714 $14.2900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 5 12.352381 $617.6300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 98 99 30.500002 $1557.0400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 13 13 9.888051 $504.7800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 108 110 85.717656 $4375.8900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 418 433 223.058641 $11387.2000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 71 71 25.346219 $1293.9400 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 7 8 16.321330 $833.2000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 42 42 38.524724 $1966.6900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 352 370 143.375443 $7319.3100 $51.0500
SCREEN-T1023 SCREENING 55 55 55.147619 $2757.3800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.043836 $0.6600 $14.9900
SPCH -92521 EVAL OF SPEECH FLUENCY 13 14 7.510656 $383.4300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 19 19 14.466667 $738.5300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 683 716 383.216199 $19563.2000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 38 38 33.778289 $1724.3800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 26 26 12.680050 $620.5700 $48.9400
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Subtotal (Total Children Is Unduplicated) 3961 6064 6769.484227 $398352.6300 $58.8500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 208 223 186.766403 $933833.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 10 9.255556 $462.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 58 59 66.773452 $3338.6700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 0.287672 $20.6000 $71.5900
AUD -92633 AUD REHAB POSTLING HEARING LOSS 8 8 5.973908 $427.8000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 46 47 43.239932 $9945.1300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 982 1172 839.363393 $41968.5200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 123 135 98.144537 $2453.6300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2584 3040 4010.350055 $200517.3500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 195 218 204.494442 $5112.3600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 956 1148 1453.520250 $72675.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 91 148 119.826186 $2995.6500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 748 828 976.249946 $48812.5500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 36 60 76.450000 $1911.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2085 2231 2476.989220 $123849.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 165 177 162.734124 $4068.3500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 14 15 31.403969 $2302.5300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 314 348 3508.555538 $87713.9000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 22.857143 $1142.8600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 8 8 22.050000 $1102.5000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7742 8616 51349.161474 $2567458.5200 $50.0000
INTR -T1013 INTERPRETER 230 255 881.485983 $44074.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4548 6453 31186.573612 $311865.7500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1267 1340 6817.448792 $487038.6000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 207 232 1196.166674 $68420.7800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1268 1333 6560.247611 $468664.1100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 87 90 496.109526 $28357.6100 $57.1600
RSPT -RSPT RESPITE 2 2 13.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 0.675495 $43.9100 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 10 10 9.873973 $2251.2500 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 3 2.866667 $653.6100 $228.0000
SENS -V5130 IN EAR BINAURAL HEARING AID
1 1 0.060274 $27.5000 $456.2000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 12 12 15.397631 $7021.3100 $456.0000
SENS -V5264 EARMOLD 57 57 51.068710 $919.2300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2175 2352 12623.200284 $901801.5200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 7 43.000001 $2459.6000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 72 75 361.311907 $5015.0100 $13.8800
TRAV -TRAVS Travel by mile 1804 2894 188349.335591 $83815.4600 $0.4500
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Subtotal (Total Children Is Unduplicated) 11219 33614 314272.269931 $6524543.2300 $20.7600
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Total 40032 321638.610693 $6923131.0200 $21.5200
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Number of Children (Unduplicated) With at Least One Authorization 12402