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 14954 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 213 214 268.321428 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 23.428572 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 16 17 258.718252 $9572.5800 $37.0000
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Subtotal (Total Children Is Unduplicated) 230 233 550.468252 $9572.5800 $17.3900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 88 99 67.698934 $3283.4000 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 92 92 91.377778 $2146.4600 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.383333 $9.0800 $23.7000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 1.172222 $59.8600 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.888889 $19.9100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.483333 $21.7500 $45.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 27 29 22.532723 $1126.6400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 434 445 654.708542 $32735.4200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 4.722222 $354.1700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 2.261111 $169.5800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 3.461111 $192.0900 $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
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
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 3 0.333333 $17.0200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 18 18 11.430138 $583.5100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.177778 $9.0800 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 3.256089 $166.2300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.333333 $17.0200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 13 7.204948 $367.8200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 3.750000 $183.5300 $48.9400
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Subtotal (Total Children Is Unduplicated) 721 798 989.480989 $48686.1500 $49.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 14 16.533333 $82666.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 2.639878 $132.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 8 8 4.363165 $218.1600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 4.888889 $1124.4500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 749 845 579.746709 $28987.5800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 44 46 30.132500 $753.3200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1571 1748 2574.655065 $128732.6800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 165 170 176.767464 $4419.2000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 730 860 1020.446423 $51022.2800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 58 92 63.313896 $1582.8700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 553 608 822.224768 $41111.2500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 21 32 40.144445 $1003.6100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1358 1428 1683.768332 $84188.4800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 147 151 141.672232 $3541.8300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 8.004762 $586.9000 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 1.422222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 4 17.571429 $439.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 230 252 1888.849219 $94442.4200 $50.0000
INTR -T1013 INTERPRETER 160 197 718.532540 $35926.6200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3522 4772 23963.758188 $239637.4000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 50 53 376.350797 $26886.5200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 17 18 64.003175 $3660.9900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 84 90 433.938094 $31000.5100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 11.107143 $634.8800 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.483333 $220.3800 $455.9700
SENS -V5264 EARMOLD 2 2 2.377777 $42.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 102 113 669.257140 $47811.7300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 12.990476 $180.3100 $13.8800
TRAV -TRAVS Travel by mile 1280 2398 170459.342556 $75854.4100 $0.4500
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Subtotal (Total Children Is Unduplicated) 5487 13923 205789.285950 $986809.3200 $4.8000
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Total 14954 207329.235191 $1045068.0500 $5.0400
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Number of Children (Unduplicated) With at Least One Authorization 5874