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 15226 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 238 246 270.264285 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 7.571428 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 36.000000 $1332.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 242 251 313.835713 $1332.0000 $4.2400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 91 97 52.797834 $2560.6800 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 25 25 25.000000 $587.2500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.577777 $13.6900 $23.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.111111 $2.4900 $22.4000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 8.571429 $417.9400 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 27 29 25.897563 $1294.8800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 419 440 679.497450 $33974.8400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 2.766667 $207.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 10 10 4.972223 $372.9200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 6 6 4.655556 $349.1700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 10 6.350000 $352.4200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 9 13.010958 $975.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 17.500000 $1312.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 23 23 38.516437 $2137.6700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 10 18.500000 $1387.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 12.714286 $635.7200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 3 0.599999 $30.6200 $51.0400
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.032877 $1.6800 $51.0800
OCTH -97166 OT EVAL MODERATE COMPLEXITY 11 12 10.966667 $559.8500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 29 30 15.030539 $767.3100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 4 0.583333 $29.7800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.444444 $73.7400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 19 20 7.911569 $403.8900 $51.0500
SCREEN-T1023 SCREENING 1 1 0.566667 $28.3400 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.333333 $17.0200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 38 39 20.685768 $1056.0000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.166667 $8.5100 $51.0600
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.861111 $42.1400 $48.9400
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Subtotal (Total Children Is Unduplicated) 683 797 971.622265 $49615.7400 $51.0600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 16 18 16.397185 $81986.5000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 1.688889 $84.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 14 14 6.477396 $323.8600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.350000 $80.5000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 700 826 535.149405 $26757.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 46 48 32.693611 $817.3500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1837 2134 2699.720756 $134986.1800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 171 183 200.551980 $5013.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 669 818 993.557936 $49677.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 62 97 74.667457 $1866.6800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 557 603 796.343940 $39817.2500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 19 28 34.844445 $871.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1357 1443 1646.802718 $82340.2100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 143 148 159.427774 $3985.6900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 18.857143 $1382.6000 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 1.422222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 3 11.571428 $289.2900 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 5.133333 $256.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 252 282 1657.880145 $82894.0000 $50.0000
INTR -T1013 INTERPRETER 171 200 676.486508 $33824.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3344 4662 22299.389334 $222993.9300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 65 68 325.926184 $23284.1900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 19 20 122.570635 $7011.0500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 80 86 364.346824 $26028.9400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 30.035714 $1716.8500 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 4 4 1.966666 $35.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 135 144 800.984116 $57222.3300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 10.285715 $142.7700 $13.8800
TRAV -TRAVS Travel by mile 1414 2332 182486.742675 $81206.6000 $0.4500
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Subtotal (Total Children Is Unduplicated) 5588 14178 216013.272134 $967126.0700 $4.4800
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Total 15226 217298.730112 $1018073.8000 $4.6900
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Number of Children (Unduplicated) With at Least One Authorization 5918