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
Eligibility Filter: Program Patients
With the filters selected there were 40545 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 320 330 339.812698 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 7.571428 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 50 51 1065.990482 $39441.6300 $37.0000
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Subtotal (Total Children Is Unduplicated) 362 383 1413.374608 $39441.6300 $27.9100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 150 163 103.314731 $5010.7500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 5.291552 $298.9200 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 2.622222 $51.6800 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 447 450 467.621428 $10984.4300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 24 24 14.896654 $206.6200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 47 47 32.816666 $777.7500 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 17 17 17.088204 $155.1600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 32 32 31.223202 $868.9400 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 12 12 8.088890 $686.2700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 6 6 3.372223 $172.2200 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 31 31 28.702380 $479.3300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 15 15 8.931734 $200.0700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 22 23 21.081309 $948.6600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 26 28 13.856848 $1593.5200 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 4 4 43.285715 $2110.6100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 39 45 59.282799 $2964.1400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 620 665 1002.676901 $50133.8200 $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 48 52 67.527624 $5064.5700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 27 35 34.311035 $2573.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 6.519331 $488.9500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 46 57 79.755329 $5981.6500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 39 50 67.605250 $3752.0900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 612 613 1058.231808 $79367.3600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 335 336 593.289182 $44496.7300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 106 106 180.224657 $13516.8400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 797 807 1194.214521 $66278.9400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 555 660 1062.215010 $79666.1900 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 5 16.566667 $828.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 5 24.725396 $1236.2800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 90 94 23.791319 $1214.5300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 12 12 8.809437 $449.7300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 93 96 72.019406 $3676.6000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 390 411 166.838268 $8517.1100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 77 80 19.587302 $999.9300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 5.250000 $268.0100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 37 37 34.440213 $1758.1700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 320 336 158.107856 $8071.3900 $51.0500
SCREEN-T1023 SCREENING 67 69 64.155557 $3207.7900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.155556 $2.3300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 8.633334 $440.7400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 26 28 13.672830 $698.0000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 596 627 326.134814 $16649.2100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 18 18 13.000000 $663.6500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 41 44 22.426864 $1097.5700 $48.9400
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Subtotal (Total Children Is Unduplicated) 4057 6182 7196.862024 $429323.3400 $59.6500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 168 187 171.976790 $859884.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 13 13.317960 $665.9000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 55 55 43.276177 $2163.7900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 10 10 2.626636 $188.0900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 52 52 78.821897 $18129.0800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1160 1354 1012.107068 $50605.8000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 124 128 92.249782 $2306.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2530 2955 3780.347591 $189017.4800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 218 235 241.917854 $6047.9400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1022 1241 1597.324069 $79866.2600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 93 150 115.500796 $2887.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 766 842 1103.545029 $55177.3100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 30 45 54.000002 $1350.0100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2006 2147 2579.142336 $128957.2400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 181 189 194.212696 $4855.3100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 17 17 76.167461 $5584.6000 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 2 2 7.422222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 299 345 4074.176167 $101854.4400 $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 7600 8377 50955.818942 $2547791.4200 $50.0000
INTR -T1013 INTERPRETER 224 264 858.076983 $42903.8500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4567 6446 30814.746160 $308147.5200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1168 1250 6316.950510 $451283.0300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 267 295 1540.592058 $88121.9100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1283 1383 6909.776350 $493634.6700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 115 127 682.117455 $38989.8500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 3.990563 $259.3900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.155556 $17.7400 $114.0300
SENS -V5050 IN EAR MONAURAL HEARING AID 13 14 5.324659 $1214.0300 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 5 5 3.220319 $734.2300 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 21 22 26.615753 $12136.8000 $456.0000
SENS -V5264 EARMOLD 60 64 60.425949 $1087.6600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2238 2452 13485.914396 $963433.9600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 17.857143 $1021.4300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 133 146 736.853968 $10227.5300 $13.8800
TRAV -TRAVS Travel by mile 1900 3155 235673.036248 $104874.5000 $0.4500
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Subtotal (Total Children Is Unduplicated) 11117 33980 363337.738878 $6575827.1800 $18.1000
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Total 40545 371947.975510 $7044592.1500 $18.9400
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Number of Children (Unduplicated) With at Least One Authorization 12312