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
Eligibility Filter: Program Patients
With the filters selected there were 41527 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 302 304 415.123807 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 23.428572 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 631 640 28562.899960 $1056827.2000 $37.0000
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Subtotal (Total Children Is Unduplicated) 894 946 29001.452339 $1056827.2000 $36.4400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 151 172 126.542542 $6137.3200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 2.337367 $132.0400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 8.377778 $165.1300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 449 451 466.093651 $10948.5400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 24 24 19.405477 $269.1500 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 45 45 55.137302 $1306.7600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 18 18 25.184126 $228.6700 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 27 27 29.910153 $832.4000 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 12 12 12.505555 $1060.9700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 20 20 10.316666 $526.8700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 33 33 47.227397 $788.7000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 13 13 20.423732 $457.4900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 18 19 18.976418 $853.9400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 19 20 11.304641 $1300.0300 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 1 1 0.428571 $26.1300 $60.9600
EVAL -96111 DEVELOPMENTAL EVALUATION 43 49 56.877586 $2843.8800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 629 650 961.979500 $48098.9600 $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 35 36 58.433180 $4382.4900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 20 24 33.733256 $2529.9900 $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 31 38 62.133105 $4659.9700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 31 35 58.388583 $3240.5600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 608 608 1055.823437 $79186.7300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 333 334 587.689182 $44076.7300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 104 104 180.027397 $13502.0500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 793 803 1189.220001 $66001.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 552 656 1060.445244 $79533.4700 $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 10 11 40.755557 $2037.7900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 74 77 20.274504 $1035.0100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 13 13 10.207534 $521.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 83 83 74.160566 $3785.8800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 427 454 245.306708 $12522.9100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 64 68 24.585445 $1255.1000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 3.316667 $169.3200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 28 28 22.165371 $1131.5300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 335 353 156.128428 $7970.4000 $51.0500
SCREEN-T1023 SCREENING 60 63 59.866667 $2993.3400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 4.701587 $70.5200 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 23 24 15.556926 $794.1900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 25 27 20.712698 $1057.3800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 547 568 289.768274 $14792.7300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 15 15 13.433334 $685.7800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 89 91 71.990248 $3523.2000 $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) 3981 6100 7260.910580 $429321.9600 $59.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 163 188 140.352739 $701762.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 12 10.339878 $517.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 45 46 43.360240 $2168.0100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 12.404762 $888.3000 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 2.205556 $157.9400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 60 61 60.279437 $13864.1700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1216 1375 1078.191261 $53910.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 121 124 96.091052 $2402.2800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2307 2576 3784.442608 $189222.0400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 225 233 244.759529 $6119.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1134 1330 1643.952257 $82197.5100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 89 141 106.052779 $2651.3200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 780 863 1143.979355 $57198.9400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 52 63.188888 $1579.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2130 2254 2668.717098 $133435.8700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 197 202 194.617473 $4865.4700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 12 12 66.665079 $4887.8900 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 3 3 12.222222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 243 274 5002.323819 $125058.0900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7778 8423 52551.349988 $2627565.9500 $50.0000
INTR -T1013 INTERPRETER 208 260 873.105556 $43655.2700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4961 6769 33837.130362 $338371.0400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1094 1183 6212.485737 $443819.7700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 394 408 1990.078580 $113832.4400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1314 1430 7577.031046 $541302.9000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 183 191 1105.473424 $63188.8300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 4.403501 $286.2300 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 1.140334 $129.9900 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 9 9 2.708219 $617.4900 $228.0100
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 16 16 15.169330 $6917.2000 $456.0000
SENS -V5264 EARMOLD 59 60 57.939727 $1042.9200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2298 2496 14760.008419 $1054454.5300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 12.880953 $736.7900 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 162 164 753.771441 $10462.3400 $13.8800
TRAV -TRAVS Travel by mile 1767 3309 226816.584236 $100933.3800 $0.4500
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Subtotal (Total Children Is Unduplicated) 11377 34481 362946.406885 $6730431.1000 $18.5400
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Total 41527 399208.769804 $8216580.2700 $20.5800
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Number of Children (Unduplicated) With at Least One Authorization 12156