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 23792 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 289 291 353.484127 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 23.428572 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 57 58 1256.761900 $46500.1900 $37.0000
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Subtotal (Total Children Is Unduplicated) 341 351 1633.674599 $46500.1900 $28.4600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 133 151 107.505251 $5214.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.109589 $6.1900 $56.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 2.377778 $46.8700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 120 120 119.377778 $2804.1800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.377778 $19.1100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 2.849999 $67.5400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.377778 $3.4300 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.377778 $10.5100 $27.8300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 8 8 2.938889 $150.0900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 9.571429 $159.8400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.888889 $42.3100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 6 5.061110 $227.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 3.950380 $454.2800 $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 34 37 29.827586 $1491.3800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 617 638 942.820596 $47141.0200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 9.833333 $737.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 7 7 9.205555 $690.4100 $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 7 9 16.261111 $1219.5800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 9 12.949923 $718.7200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 65 65 81.587669 $6119.0600 $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 141 141 157.825497 $8759.3200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 48 54 90.583560 $6793.7700 $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 1 1 1.500000 $75.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 10 11 4.333334 $221.2200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.288889 $65.8000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 15 15 17.441672 $890.3900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 58 65 42.439117 $2166.5200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 9 9 2.005557 $102.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.189041 $9.6500 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 37 39 16.613200 $848.1100 $51.0500
SCREEN-T1023 SCREENING 5 5 5.000000 $250.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 4.701587 $70.5200 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 6 7 4.593151 $234.4800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 3.194444 $163.0700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 86 88 67.699663 $3456.0700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 19 19 15.555555 $761.2900 $48.9400
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Subtotal (Total Children Is Unduplicated) 1328 1594 1877.978346 $98050.3300 $52.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 34 44 46.197716 $230988.0000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 6 2.762100 $138.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 19 17.856816 $892.8400 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 12.404762 $888.3000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 15 16 12.942389 $2976.7300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1056 1187 862.369978 $43118.8800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 59 61 45.475557 $1136.9000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2264 2530 3743.258642 $187162.8300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 223 231 243.188100 $6079.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1104 1300 1609.082916 $80454.0300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 88 140 105.052779 $2626.3200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 753 835 1121.586500 $56079.3100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 33 49 58.122222 $1453.0600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2088 2211 2615.778665 $130788.9300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 193 198 190.617473 $4765.4700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 6 6 12.293651 $901.3700 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 3 3 12.222222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 30 39 220.571427 $5514.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1559 1700 11256.759876 $562837.7500 $50.0000
INTR -T1013 INTERPRETER 196 243 848.784127 $42439.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4961 6767 33830.330362 $338303.0400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 164 173 1071.226992 $76528.4100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 56 60 263.235713 $15057.0800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 206 222 1094.692062 $78204.7500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 13 14 60.821428 $3476.5600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.836834 $119.3900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 1.140334 $129.9900 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.372603 $84.9500 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 5 3.475722 $1584.8700 $455.9800
SENS -V5264 EARMOLD 12 13 13.072602 $235.3100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 412 444 2643.645243 $188861.9600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.666667 $152.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 15 15 77.274605 $1072.5700 $13.8800
TRAV -TRAVS Travel by mile 1767 3308 226808.012807 $100929.5700 $0.4500
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Subtotal (Total Children Is Unduplicated) 8489 21847 288909.131892 $2165983.0200 $7.5000
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Total 23792 292420.784837 $2310533.5400 $7.9000
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Number of Children (Unduplicated) With at Least One Authorization 9050