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: 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 28279 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 216 217 321.776983 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 23.428572 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 497 503 25154.672194 $930722.7900 $37.0000
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Subtotal (Total Children Is Unduplicated) 683 722 25499.877749 $930722.7900 $36.5000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 91 103 71.698934 $3477.4000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 2.227778 $125.8500 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 4.000000 $78.8400 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 297 298 305.377778 $7173.3200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 17 17 14.544443 $201.7300 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 25 25 29.120636 $690.1600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 9 17.528571 $159.1600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 16 16 22.818982 $635.0500 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 7 7 7.361111 $624.5200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 11 11 6.261111 $319.7500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 24 24 31.455968 $525.3200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 16.007143 $358.5600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 2.573288 $115.8000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 8 3.530061 $405.9600 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 31 35 23.227167 $1161.3600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 436 447 658.708542 $32935.4200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 4 7.500000 $562.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 24 25 39.594368 $2969.5800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 18 22 29.249923 $2193.7400 $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 19 21 28.799772 $2159.9700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 21 25 40.899771 $2269.9300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 408 408 716.669818 $53750.2300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 249 250 450.109735 $33758.2500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 67 67 114.024657 $8551.8500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 536 544 825.383545 $45808.8200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 391 469 757.456208 $56809.2600 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.244444 $62.2200 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 12.533333 $626.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 19.338095 $966.9100 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 58 61 13.380059 $683.0400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 2.748782 $140.3300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 61 61 53.882973 $2750.7200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 292 304 141.659927 $7231.7400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 40 44 9.044966 $461.7400 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.316667 $16.1700 $51.0600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 20 20 17.554108 $896.1300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 238 250 108.245160 $5525.9600 $51.0500
SCREEN-T1023 SCREENING 37 39 36.566667 $1828.3400 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 14 15 10.969330 $559.9900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 13 15 7.505555 $383.1600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 297 313 137.971459 $7043.4900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 8 8 7.966667 $406.7000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 54 55 31.410883 $1537.2500 $48.9400
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 1 1 0.261111 $19.7700 $75.7200
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Subtotal (Total Children Is Unduplicated) 2631 4058 4846.240607 $289575.9700 $59.7500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 102 117 81.286758 $406433.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 7 4.506545 $225.3300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 13 13 9.140943 $457.0500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 1.205556 $86.3300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 36 36 43.584919 $10024.4800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 855 972 729.683963 $36484.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 88 91 67.305648 $1682.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1595 1774 2598.244738 $129912.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 166 171 177.767464 $4444.2000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 751 881 1042.687194 $52134.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 59 93 64.313896 $1607.8700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 571 627 838.767623 $41938.3800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 22 34 44.211111 $1105.2800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1374 1444 1697.437076 $84871.9300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 151 155 145.672232 $3641.8300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 10 62.376190 $4573.4200 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 1.422222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 193 216 3974.895248 $99372.3700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5583 6031 37664.297986 $1883213.7800 $50.0000
INTR -T1013 INTERPRETER 168 205 730.782540 $36539.1200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3522 4772 23963.758188 $239637.4000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 668 719 3742.322225 $267351.4600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 272 282 1369.942469 $78360.6700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 835 903 4925.606743 $351885.1900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 147 153 909.425804 $51982.7400 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 1.936986 $441.6400 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 4 2.161111 $985.4600 $456.0000
SENS -V5264 EARMOLD 22 22 18.079604 $325.4300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1149 1242 7518.469085 $537119.2400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 10.214286 $584.2600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 112 114 480.270641 $6666.1500 $13.8800
TRAV -TRAVS Travel by mile 1280 2398 170459.342556 $75854.4100 $0.4500
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Subtotal (Total Children Is Unduplicated) 7680 23499 263381.119550 $4409942.5000 $16.7400
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Total 28279 293727.237906 $5630241.2600 $19.1700
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Number of Children (Unduplicated) With at Least One Authorization 8199