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: 01-01-19 and 03-31-19 Date of Report: 05-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 28219 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 240 248 270.935714 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 7.571428 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 41 42 963.493656 $35649.2500 $37.0000
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Subtotal (Total Children Is Unduplicated) 274 292 1242.000798 $35649.2500 $28.7000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 99 106 59.238093 $2873.0400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 6 4.291552 $242.4300 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.7100 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 313 315 322.842857 $7583.5800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 14 5.066669 $70.2800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 31 31 17.533333 $415.5400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 6 6.000000 $54.4800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 15 15 13.156165 $366.1300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $38.4700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 2.255556 $191.3700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 0.566667 $28.9400 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 22 22 18.772222 $313.5000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 10 4.240638 $94.9900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 5.307936 $238.8600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 15 6.343836 $729.5300 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 8.571429 $417.9400 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 29 33 25.942007 $1297.1000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 422 443 684.497450 $34224.8400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 5 8.500000 $637.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 34 38 42.922145 $3219.1600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 25 33 29.311035 $2198.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 6.511111 $488.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 31 37 41.655329 $3124.1500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 29 40 49.599771 $2752.7800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 412 413 719.078189 $53930.8500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 251 252 455.709735 $34178.2500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 69 69 114.221917 $8566.6400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 538 546 829.271216 $46024.5900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 394 473 759.225974 $56941.9900 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 12.714286 $635.7200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 12.142857 $607.1500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 62 66 15.135763 $772.6600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 4.448326 $227.0900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 63 65 45.939955 $2345.2400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 270 282 98.626886 $5034.9100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 53 56 13.487302 $688.5300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 22 22 20.071568 $1024.6500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 227 237 111.442037 $5689.1000 $51.0500
SCREEN-T1023 SCREENING 39 40 37.644446 $1882.2300 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 5.938889 $303.1800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 14 16 7.000608 $357.3800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 348 368 152.063244 $7762.8400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 12 12 9.766667 $498.5900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 27 29 11.851522 $580.0200 $48.9400
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Subtotal (Total Children Is Unduplicated) 2732 4155 4803.907188 $289825.7000 $60.3300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 100 114 88.570852 $442855.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 4.822222 $241.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 26 26 20.344062 $1017.1900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 0.958904 $68.6700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 21 21 47.345032 $10889.3700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 803 951 681.054118 $34052.9900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 91 95 69.342156 $1733.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1865 2166 2723.147992 $136157.5500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 172 184 201.551980 $5038.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 680 830 1000.800252 $50040.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 63 98 75.667457 $1891.6800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 570 618 804.132829 $40206.7000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 19 28 34.844445 $871.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1373 1460 1661.421765 $83071.1600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 147 152 163.427774 $4085.6900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 12 12 39.254762 $2878.1500 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 1.422222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 238 271 3543.326966 $88583.2000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 3 8.133333 $406.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5627 6179 37591.702090 $1879585.3500 $50.0000
INTR -T1013 INTERPRETER 180 209 700.879365 $35043.9700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3344 4662 22299.389334 $222993.9300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 712 759 3715.178539 $265412.4600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 186 208 1056.406346 $60426.4800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 813 876 4371.218441 $312279.9400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 87 98 539.931738 $30862.5100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 9 10 2.736988 $624.0400 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 3 2.136986 $487.2400 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 5 6.077778 $2771.4800 $456.0000
SENS -V5264 EARMOLD 25 26 18.446878 $332.0400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1165 1264 6698.883074 $478568.3400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 16.571429 $947.8800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 85 95 435.127777 $6039.5700 $13.8800
TRAV -TRAVS Travel by mile 1414 2333 182487.809342 $81207.0800 $0.4500
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Subtotal (Total Children Is Unduplicated) 7719 23772 271113.065228 $4281735.8800 $15.7900
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Total 28219 277158.973214 $4607210.8300 $16.6200
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Number of Children (Unduplicated) With at Least One Authorization 8542