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: 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 25777 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 232 234 308.308724 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 6 19.590476 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 3.533333 $130.7300 $37.0000
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Subtotal (Total Children Is Unduplicated) 239 243 331.432533 $130.7300 $0.3900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 103 117 75.145699 $3644.5700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 6 2.828082 $159.7600 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 181 184 183.387454 $4307.7700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 1.577777 $21.8800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 32 32 23.405555 $554.7100 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 6 6.833333 $62.0500 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 9 9 7.301370 $203.2000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.266667 $10.2600 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 2.500001 $212.1100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 8 8 5.322222 $271.8000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 12 12 10.114308 $168.9100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 1.646575 $36.8800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.200000 $9.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 2.393606 $275.2600 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 11.571429 $564.2200 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 27 37 37.855401 $1892.7700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 388 405 594.577483 $29728.8900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 20 21 24.577777 $1843.3300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 14 17.805478 $1335.4100 $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 22 27 26.424429 $1981.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 26 32 37.960503 $2106.8200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 347 349 623.257724 $46744.3400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 217 219 400.145396 $30010.9200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 45 45 83.515068 $6263.6300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 533 533 777.956934 $43176.6400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 436 491 711.019957 $53326.5200 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 4.571429 $228.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 11.857143 $592.8600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 52 57 10.649924 $543.6800 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 6 6 4.755556 $242.7700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 53 56 41.194444 $2102.9700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 245 254 117.690639 $6008.1100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 42 43 10.496826 $535.8700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.450000 $22.9700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 30 31 48.253187 $2463.3300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 220 232 127.495125 $6508.6100 $51.0500
SCREEN-T1023 SCREENING 39 39 36.222224 $1811.1200 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 3.166666 $161.6500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 13 13 7.739877 $395.1200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 326 342 171.823380 $8771.6200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 12 12 9.855556 $503.1300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 19 19 8.367199 $409.4900 $48.9400
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Subtotal (Total Children Is Unduplicated) 2373 3694 4290.226588 $260668.8900 $60.7600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 101 115 96.676655 $483381.5000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 3.700000 $185.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 25 25 15.983792 $799.2000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 0.049771 $3.5600 $71.5100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 14.082094 $1008.4200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 32 32 40.404326 $9292.9700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 691 847 585.467552 $29273.5500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 78 80 62.923182 $1573.0800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1654 1908 2799.539670 $139976.9400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 187 212 235.325111 $5883.1200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 650 789 1039.799422 $51989.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 72 125 116.322219 $2908.0500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 473 532 727.367148 $36368.3800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 30 51 53.572221 $1339.3000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1238 1293 1650.989473 $82549.3600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 175 186 199.983328 $4999.5700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 13 13 50.101588 $3673.4400 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 220 228 3196.285724 $79907.1400 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 8.888889 $444.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5379 5776 40106.052792 $2005302.3800 $50.0000
INTR -T1013 INTERPRETER 183 206 770.421637 $38521.1000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3334 4432 24595.258180 $245952.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 615 640 3791.264328 $270847.8500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 207 222 1157.919067 $66232.9300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 629 665 3905.566587 $279013.4800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 113 119 651.333342 $37230.1900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.200000 $13.0000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 2.424657 $552.8300 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.466667 $106.4100 $228.0200
SENS -V5264 EARMOLD 23 23 17.694064 $318.4900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 978 1034 6645.158408 $474729.8200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 4.428572 $253.3100 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 93 93 427.945240 $5939.8700 $13.8800
TRAV -TRAVS Travel by mile 1179 2169 186379.795587 $82939.0100 $0.4500
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Subtotal (Total Children Is Unduplicated) 7150 21840 279353.391293 $4443510.1600 $15.9100
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Total 25777 283975.050414 $4704309.7800 $16.5700
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Number of Children (Unduplicated) With at Least One Authorization 7669