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 21281 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 285 288 352.394439 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 6 19.590476 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 2.833333 $104.8300 $37.0000
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Subtotal (Total Children Is Unduplicated) 290 295 374.818248 $104.8300 $0.2800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 124 141 95.988392 $4655.4400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.850000 $16.7500 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 46 46 44.850000 $1053.5300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.039041 $14.4100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 2.533332 $60.0400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 7 13.564286 $123.1600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 12.564286 $349.6600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.533333 $20.5200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 5 5.900000 $500.5600 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 7 7 13.564286 $226.5200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.533333 $11.9500 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.277778 $12.5000 $45.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 33 43 41.592617 $2079.6300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 547 581 838.969565 $41948.4900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 6.055555 $454.1600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 4.633333 $347.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 7 7.172222 $537.9200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 9 8.100000 $449.5500 $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 98 107.792952 $5982.5100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 63 65 109.496672 $8212.2500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 4.571429 $228.5700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 9 1.583334 $80.8300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 1.421841 $72.5800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 13 13 21.442064 $1094.6200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 39 40 17.373667 $886.9200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 5 1.016667 $51.9000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 8 14.928366 $762.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 42 43 32.016089 $1634.4200 $51.0500
SCREEN-T1023 SCREENING 8 8 5.000000 $250.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.350000 $119.9700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.416667 $21.2700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 90 94 54.549819 $2784.7700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 0.861112 $42.1500 $48.9400
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Subtotal (Total Children Is Unduplicated) 1100 1354 1611.741057 $85409.6100 $52.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 33 39 54.833788 $274168.0000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.388889 $69.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 17 17 9.417123 $470.8600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.049315 $3.5300 $71.5900
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 6.753968 $1553.4200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 836 1008 646.232037 $32311.8700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 53 63 42.013340 $1050.3400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2238 2571 3836.547733 $191827.3100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 240 269 302.782253 $7569.5500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 937 1129 1525.679978 $76283.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 97 163 155.171425 $3879.2800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 643 723 974.142587 $48707.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 39 67 67.688888 $1692.2200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1812 1909 2495.501898 $124775.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 231 245 280.042057 $7001.0300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 13.542063 $992.9000 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 30 34 258.523813 $6463.0900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 55.714286 $2785.7200 $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 1370 1502 10602.659226 $530132.9200 $50.0000
INTR -T1013 INTERPRETER 202 230 831.102949 $41555.1600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4507 6024 33322.875467 $333228.7000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 162 165 1056.987310 $75511.1900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 27 27 169.780956 $9711.4700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 144 150 996.595247 $71196.7200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 15 16 81.520636 $4659.7200 $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 1 1 1.000000 $114.0000 $114.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 3 3 1.319407 $23.7500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 340 357 2556.376204 $182627.4800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 57.857143 $803.0600 $13.8800
TRAV -TRAVS Travel by mile 1565 2891 236933.087662 $105435.2300 $0.4500
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Subtotal (Total Children Is Unduplicated) 7747 19632 297363.109870 $2138309.0800 $7.1900
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Total 21281 299349.669175 $2223823.5300 $7.4300
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Number of Children (Unduplicated) With at Least One Authorization 8239