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
Eligibility Filter: Program Patients
With the filters selected there were 36887 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 293 296 362.108725 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 6 19.590476 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 6.366666 $235.5600 $37.0000
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Subtotal (Total Children Is Unduplicated) 301 306 388.065867 $235.5600 $0.6100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 144 163 118.998785 $5771.4400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 3.828082 $216.2500 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 1.850000 $36.4600 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 292 295 295.250153 $6935.4300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 17 18 14.750151 $204.5800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 51 51 41.438887 $982.1000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 18 18 25.508731 $231.6200 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 22 22 25.401730 $706.9300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 1.800000 $69.2500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 16 16 22.422224 $1902.3200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 12 12 8.800000 $449.4200 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 21 21 24.834150 $414.7300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 9 6.491020 $145.4000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 11 9.485997 $426.8700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 12 7.782723 $895.0100 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 2 2 29.000000 $1414.0400 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 34 46 44.314839 $2215.7400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 560 594 857.969565 $42898.4900 $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 28 29 33.705555 $2527.9100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 17 19 24.072145 $1805.4100 $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 32 40 43.224429 $3241.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 34 42 47.638281 $2643.9400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 509 511 910.329181 $68274.7200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 288 291 531.815648 $39886.2000 $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 1059.458693 $58799.9900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 587 663 986.270639 $73970.3300 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 17.428572 $871.4300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 5 41.314286 $2065.7200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 78 85 19.822146 $1011.9200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 11 11 7.521841 $383.9900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 88 91 80.142975 $4091.2900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 346 358 165.442271 $8445.8400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 61 62 16.857937 $860.6000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 1.600685 $81.7200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 42 43 66.475693 $3393.5900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 314 331 199.617488 $10190.4600 $51.0500
SCREEN-T1023 SCREENING 60 60 61.903176 $3095.1700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.041552 $15.6200 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 12 12 7.538889 $384.8600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 23 24 14.428766 $736.5900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 553 584 316.855454 $16175.5200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 19 19 25.108731 $1281.8000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 30 30 14.800533 $724.3400 $48.9400
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Subtotal (Total Children Is Unduplicated) 3488 5431 6361.944581 $380447.0000 $59.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 161 182 171.782023 $858908.0000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 10 7.419634 $370.9800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 53 55 36.774965 $1838.7600 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 0.049771 $3.5600 $71.5100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 9 14.673571 $1050.7800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 53 54 62.472069 $14368.5600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1001 1195 847.762700 $42388.4100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 123 134 99.079457 $2477.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2270 2604 3864.946621 $193247.2400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 240 269 302.782253 $7569.5500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 963 1155 1545.917281 $77295.8200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 97 163 155.171425 $3879.2800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 666 749 997.885921 $49894.2700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 40 69 73.555554 $1838.8900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1842 1939 2518.436676 $125921.7400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 232 246 281.042057 $7026.0300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 17 17 84.153175 $6170.1100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 270 282 3952.523821 $98813.0900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 104.285715 $5214.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 24.722222 $1236.1100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7386 7954 54983.094616 $2749154.4100 $50.0000
INTR -T1013 INTERPRETER 214 246 885.245806 $44262.3100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4509 6027 33343.446896 $333434.4200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1015 1060 6370.973836 $455142.2800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 282 305 1611.546455 $92180.4200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1009 1076 6408.758669 $457841.4100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 141 149 825.496834 $47185.3700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.200000 $13.0000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 1.833333 $209.0000 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 2.808219 $640.2900 $228.0100
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.466667 $106.4100 $228.0200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 7 7.455555 $3399.7100 $456.0000
SENS -V5264 EARMOLD 39 39 30.399773 $547.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1959 2100 13824.308463 $987608.0300 $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 141 142 724.278578 $10052.9800 $13.8800
TRAV -TRAVS Travel by mile 1565 2892 236944.373376 $105440.2500 $0.4500
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Subtotal (Total Children Is Unduplicated) 10386 31150 371114.552559 $6786983.2300 $18.2900
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Total 36887 377864.563007 $7167665.8000 $18.9700
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Number of Children (Unduplicated) With at Least One Authorization 11112