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 23384 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 310 320 332.751587 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 7.571428 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 6 6 66.095238 $2445.5300 $37.0000
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Subtotal (Total Children Is Unduplicated) 317 328 406.418253 $2445.5300 $6.0200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 131 140 86.368763 $4188.8700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.622222 $12.2600 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 56 56 56.000000 $1315.4400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.916666 $26.5800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 0.999999 $23.7000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 3.622222 $32.8900 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 5.916666 $164.6600 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 2.116667 $179.5800 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 6.580158 $109.8900 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 0.544444 $12.1900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 1.779604 $80.0800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 1.906163 $219.2000 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 2 2 11.000000 $536.3600 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 33 36 33.060577 $1653.0300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 604 648 975.517997 $48775.8700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 11 12.366667 $927.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 11 11 7.972223 $597.9200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.008220 $0.6200 $74.8200
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 15 21.588889 $1619.1700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 16 16 16.355479 $907.7300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 64 64 79.587669 $5969.0600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 40 40 61.546572 $4616.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 4.002740 $300.2000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 141 141 156.825497 $8703.8200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 48 54 90.583560 $6793.7700 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 13.280953 $664.0500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 9 2.316665 $118.2600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.032877 $52.7300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 23 24 21.661111 $1105.8000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 64 67 37.463928 $1912.5400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 14 14 3.116666 $159.1000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 5.501978 $280.8700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 44 47 23.161427 $1182.3900 $51.0500
SCREEN-T1023 SCREENING 7 7 5.588889 $279.4500 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.311112 $15.8900 $51.0600
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 0.822222 $41.9700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 113 118 74.757933 $3816.3800 $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) 1276 1584 1830.833203 $97554.0300 $53.2800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 46 50 61.365298 $306827.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 1.917960 $95.9000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 21 21 14.197868 $709.8800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 10 10 8.238889 $1894.9500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 994 1158 788.684993 $39434.6400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 59 61 40.970001 $1024.2600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2490 2911 3741.767179 $187088.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 216 233 240.346425 $6008.6600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 999 1217 1570.227785 $78511.4300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 92 149 114.500796 $2862.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 744 817 1081.412489 $54070.6800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 29 44 53.000002 $1325.0100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1975 2113 2543.112178 $127155.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 177 185 190.212696 $4755.3100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 21.285714 $1560.6700 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 2 2 7.422222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 37 49 230.992058 $5774.8100 $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 1501 1663 10306.604573 $515330.3700 $50.0000
INTR -T1013 INTERPRETER 209 246 822.984126 $41149.2100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4567 6445 30805.889017 $308058.9500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 180 188 960.773803 $68637.6700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 34 35 196.392065 $11233.6400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 214 229 1159.119830 $82807.5600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 13 13 60.464286 $3456.1500 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.487671 $339.2000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.294444 $67.1200 $227.9700
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 2.688889 $1226.1400 $456.0000
SENS -V5264 EARMOLD 11 12 6.587670 $118.5800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 401 433 2501.054742 $178675.4000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 16 17 107.819050 $1496.5300 $13.8800
TRAV -TRAVS Travel by mile 1900 3154 235671.969581 $104874.0300 $0.4500
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Subtotal (Total Children Is Unduplicated) 8396 21472 293318.917633 $2136827.0700 $7.2800
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Total 23384 295556.169089 $2236826.6200 $7.5700
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Number of Children (Unduplicated) With at Least One Authorization 8913