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 22978 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 328 334 555.691456 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 7 24.409523 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.788889 $29.1900 $37.0000
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Subtotal (Total Children Is Unduplicated) 334 342 580.889868 $29.1900 $0.0500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 145 169 102.103098 $4952.0200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 1.799543 $101.6500 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.194444 $3.8300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 62 62 61.194444 $1437.4600 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.694444 $23.5000 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 3.694445 $87.5600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 2.694444 $24.4700 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 1.694444 $47.1600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $38.4700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.316666 $111.7000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.194444 $19.9500 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 3.338889 $74.7900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 5 2.538052 $114.2100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 6 2.562862 $294.7300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 30 40 42.983179 $2149.1600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 521 543 850.911501 $42545.5800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 17 17 20.494445 $1537.0900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 16 16 10.027778 $752.0900 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 14 14 18.638890 $1397.9300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 14 15 10.027778 $556.5400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 43 43 74.027395 $5552.0600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 30 30 54.153815 $4061.5400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 8.017809 $601.3400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 98 98 133.491582 $7408.7800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 63 65 109.496672 $8212.2500 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 23 23 6.916665 $353.0900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.024658 $154.4100 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 15 15 14.557763 $743.1800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 59 60 23.027703 $1175.5700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 12 12 3.533332 $180.3700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 4.046652 $206.5800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 58 59 23.728942 $1211.3700 $51.0500
SCREEN-T1023 SCREENING 3 3 3.033333 $151.6700 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 2.605099 $132.9900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 2.027778 $103.5200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 123 130 72.798695 $3716.3600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 2.922222 $149.1800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 1.958752 $95.8600 $48.9400
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Subtotal (Total Children Is Unduplicated) 1191 1488 1685.472657 $90582.1000 $53.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 54 58 57.544804 $287724.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.411111 $20.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 24 24 27.280812 $1364.0400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.142857 $225.0600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 6 7 4.144444 $953.2100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 827 992 644.322489 $32216.4500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 53 63 38.713341 $967.8400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2551 3005 3973.369102 $198668.3000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 195 218 204.494442 $5112.3600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 942 1132 1433.831359 $71691.4800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 91 148 119.826186 $2995.6500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 724 802 953.451533 $47672.6200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 36 60 76.450000 $1911.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2064 2209 2457.815412 $122890.6400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 164 176 161.734124 $4043.3500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 6 6 9.807143 $719.0600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 42 45 317.666666 $7941.6600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 10.000000 $500.0000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 6 20.800000 $1040.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1481 1638 9879.126601 $493956.3500 $50.0000
INTR -T1013 INTERPRETER 220 241 818.200269 $40910.0400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4544 6448 31161.765676 $311617.6700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 214 223 1115.766668 $79710.3700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 27 27 174.107144 $9958.9300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 221 230 1052.888884 $75218.4000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 12 12 102.142859 $5838.4900 $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 -V5050 IN EAR MONAURAL HEARING AID 3 3 1.413699 $322.3200 $228.0000
SENS -V5130 IN EAR BINAURAL HEARING AID
1 1 0.060274 $27.5000 $456.2000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 12 12 6.157914 $110.8400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 423 449 2565.233622 $183260.2800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.857143 $506.6300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 15 15 108.321431 $1503.5000 $13.8800
TRAV -TRAVS Travel by mile 1801 2890 188320.002258 $83802.4000 $0.4500
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Subtotal (Total Children Is Unduplicated) 8428 21148 245833.757465 $2075879.5300 $8.4400
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Total 22978 248100.119990 $2166490.8200 $8.7300
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Number of Children (Unduplicated) With at Least One Authorization 8957