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
Eligibility Filter: Program Patients
With the filters selected there were 42576 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 380 388 606.342053 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 10.228571 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 723 744 32294.311905 $1194889.5900 $37.0000
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Subtotal (Total Children Is Unduplicated) 1053 1135 32910.882529 $1194889.5900 $36.3100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 138 163 114.224654 $5539.9000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 4.845282 $273.7100 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 8 8 10.638889 $209.6900 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 445 448 466.219842 $10951.5100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 29 29 30.191097 $418.7500 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 50 51 54.788097 $1298.4800 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 21 21 21.935540 $199.1700 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 25 25 26.179985 $728.5900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 2.005556 $77.1600 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 18 19 23.605555 $2002.6900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 21 21 12.283333 $627.3100 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 30 30 29.218233 $487.9400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 14 14 13.746652 $307.9300 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 17 19 12.587595 $566.4400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 17 19 10.946269 $1258.8000 $115.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 1 1 11.285714 $687.9800 $60.9600
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 10.571429 $515.4600 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 52 61 53.253234 $2662.6700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 660 689 1136.185195 $56809.2800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 8 7.504110 $562.8100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 54 55 82.716820 $6203.7600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 23 24 31.313621 $2348.5300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 15 15 14.108221 $1058.1100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 55 79 92.694522 $6952.0900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 75 84 98.091002 $5444.0200 $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 683 685 1112.022318 $83401.5800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 315 315 566.922693 $42519.2200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 178 178 127.480849 $9560.9300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 884 898 1332.163798 $73935.0100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 585 673 1050.433267 $78782.4900 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 7.719047 $385.9500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 10 29.236509 $1461.8300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 89 92 24.496834 $1250.6100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 11 11 7.961871 $406.4600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 76 79 68.911001 $3517.9200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 406 438 242.837166 $12396.8300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 72 75 15.472227 $789.8800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 7 7 6.127778 $312.8200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 37 38 32.741552 $1671.4500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 336 375 184.590080 $9423.3700 $51.0500
SCREEN-T1023 SCREENING 51 52 53.992061 $2699.6000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 4 3.623810 $54.3600 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 12 13 4.683867 $239.1100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 20 20 16.794444 $857.3500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 533 549 288.534329 $14729.7200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 17 17 14.216667 $725.7600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 62 65 38.293226 $1874.0700 $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) 4239 6494 7602.940286 $449351.4100 $59.1000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 155 190 166.260882 $831305.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 10 7.164993 $358.2500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 45 48 59.596361 $2979.8300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.428571 $102.3000 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 8 8 6.266667 $448.7600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 58 59 55.861656 $12848.2100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1161 1372 1221.591047 $61079.8700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 158 165 124.529442 $3113.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2144 2437 3498.409087 $174920.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 224 245 290.821434 $7270.5500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1158 1362 1701.211763 $85060.5800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 96 143 151.043650 $3776.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 762 863 1058.871793 $52943.5900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 63 62.355560 $1558.9000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2087 2233 2497.307651 $124865.3100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 208 223 271.394444 $6784.8600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 10 52.117460 $3821.2600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 374 503 5821.599205 $145539.9900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 50.714286 $2535.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7693 8521 52752.655762 $2637633.8200 $50.0000
INTR -T1013 INTERPRETER 229 270 857.709080 $42885.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4906 6922 34351.624422 $343516.3000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1098 1194 6045.308269 $431876.9000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 410 475 2368.863487 $135498.9700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1228 1328 6520.679357 $465837.5700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 180 215 1024.817949 $58578.5400 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 3.010655 $195.7000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 3 0.865753 $98.7000 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 11 12 4.759511 $1085.1700 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 17 18 16.965450 $7736.2700 $456.0000
SENS -V5264 EARMOLD 62 66 63.845207 $1149.2200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2173 2384 13354.851549 $954070.8000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 7.496032 $428.7700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 166 202 860.488096 $11943.5600 $13.8800
TRAV -TRAVS Travel by mile 1941 3392 214329.023302 $95376.4200 $0.4500
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Subtotal (Total Children Is Unduplicated) 11426 34947 349662.509833 $6709453.4600 $19.1900
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Total 42576 390176.332648 $8353694.4500 $21.4100
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Number of Children (Unduplicated) With at Least One Authorization 12907