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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 29699 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 292 298 510.410310 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 10.228571 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 561 580 26032.350789 $963197.0200 $37.0000
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Subtotal (Total Children Is Unduplicated) 813 881 26552.989670 $963197.0200 $36.2700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 85 101 70.964683 $3441.7700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 4.277778 $241.6500 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 4.000000 $78.8400 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 293 296 302.714286 $7110.7600 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 17 17 15.911112 $220.6900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 26 26 27.493652 $651.6000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 10 10 10.633333 $96.5500 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 14 14 15.900000 $442.5000 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 10 10 12.427778 $1054.3700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 10 10 7.316667 $373.6600 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 21 21 19.063470 $318.3600 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 8.000000 $179.2000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 9 3.788356 $170.4700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 10 4.084779 $469.7400 $115.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 1 1 11.285714 $687.9800 $60.9600
EVAL -96111 DEVELOPMENTAL EVALUATION 43 50 42.555934 $2127.8100 $50.0000
EXIT -EXIT EXIT ASSESSMENT 498 515 850.218212 $42510.9300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 5.293151 $396.9800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 39 39 63.515069 $4763.6300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 16 16 21.851140 $1638.8400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 12.012330 $900.9200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 42 60 77.375800 $5803.1800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 54 58 72.278670 $4011.4500 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.500000 $83.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 450 451 764.658906 $57349.3600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 229 229 412.602734 $30945.2200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 109 109 100.705494 $7552.8300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 621 633 980.927388 $54441.4500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 429 494 775.121911 $58134.1600 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 4.433333 $221.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 3 3.485714 $174.2900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 66 67 15.938895 $813.7100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.094444 $157.9700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 50 53 37.233419 $1900.7700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 287 313 165.323100 $8439.7600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 47 48 10.055561 $513.3600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 5.127778 $261.7700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 28 29 25.892390 $1321.8100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 238 269 118.720165 $6060.7300 $51.0500
SCREEN-T1023 SCREENING 35 35 32.295236 $1614.7600 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 7 8 2.051218 $104.7100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 12 12 8.700000 $444.1400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 302 316 151.398643 $7728.9100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 10 10 10.000000 $510.5000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 41 44 22.378006 $1095.1800 $48.9400
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 2 2 1.044445 $79.0900 $75.7200
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Subtotal (Total Children Is Unduplicated) 2895 4430 5315.650694 $317641.2500 $59.7600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 91 113 84.403272 $422016.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 7 5.942771 $297.1400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 20 21 32.138467 $1606.9300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 7 7 5.266667 $377.1500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 41 41 42.203968 $9706.9200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 819 963 853.005635 $42650.4500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 111 115 85.367075 $2134.1900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1499 1696 2403.597036 $120179.8300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 173 187 241.938097 $6048.4600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 766 912 1149.424863 $57471.2600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 68 103 102.566665 $2564.1600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 560 637 764.295808 $38214.8200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 32 48 47.944447 $1198.6200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1357 1444 1609.785889 $80489.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 165 177 220.027776 $5500.6900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 9 9 49.561904 $3633.8800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 304 413 4557.583336 $113939.5900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 50.714286 $2535.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5603 6229 38422.432013 $1921122.3100 $50.0000
INTR -T1013 INTERPRETER 188 222 656.667808 $32833.4100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3553 5020 24734.641940 $247346.4500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 669 731 3583.301574 $255991.1200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 296 341 1732.823803 $99117.5000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 780 839 4060.756350 $290100.5200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 151 181 850.668742 $48624.1800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.377778 $24.5600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 6 7 2.931506 $668.3800 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 9 9 8.744445 $3987.4900 $456.0000
SENS -V5264 EARMOLD 36 38 38.287826 $689.1900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1120 1237 6636.691255 $474125.2700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 4.962699 $283.8700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 111 140 554.738096 $7699.7500 $13.8800
TRAV -TRAVS Travel by mile 1423 2497 159352.993799 $70912.0800 $0.4500
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Subtotal (Total Children Is Unduplicated) 7903 24388 252946.787596 $4364091.6000 $17.2500
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Total 29699 284815.427960 $5644929.8800 $19.8200
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Number of Children (Unduplicated) With at Least One Authorization 8937