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 24335 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 364 372 595.861893 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 10.228571 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 59 60 2324.040479 $85989.5000 $37.0000
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Subtotal (Total Children Is Unduplicated) 419 435 2930.130943 $85989.5000 $29.3500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 115 135 92.029982 $4463.4500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.567504 $32.0600 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 2.638889 $52.0100 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 108 108 108.005556 $2537.0500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 2.638889 $36.6000 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 10 10 7.388889 $175.1200 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 0.638889 $5.8000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.638889 $17.7800 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.005556 $0.2200 $38.7700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 4.166667 $353.5000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 8 8 2.327778 $118.8800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 3.576985 $59.7400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 0.050000 $1.1200 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.222222 $55.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.326027 $37.4900 $114.9900
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 10.571429 $515.4600 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 44 52 45.287327 $2264.3700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 651 680 1121.185195 $56059.2800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 0.210959 $15.8300 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 12 11.692010 $876.9100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 2.486073 $186.4600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 0.095891 $7.1900 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 3.535388 $265.1600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 21 9.550982 $530.0600 $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 98 98 88.713707 $6653.4900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 38 38 54.336396 $4075.2400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 58 58 4.275356 $320.5900 $74.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 195 195 213.317233 $11839.0400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 75 78 102.157541 $7661.7800 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 4.433333 $221.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 9 5.505556 $281.0600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 0.722222 $36.8700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 12 11.183562 $570.9200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 44 48 27.049161 $1380.8600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 11 2.183334 $111.4600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 4.060274 $207.2800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 31 33 25.088107 $1280.7500 $51.0500
SCREEN-T1023 SCREENING 6 6 8.785714 $439.2900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.957143 $14.3600 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 1.427093 $72.8500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 4.094444 $209.0200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 78 78 52.945891 $2702.8800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.016667 $0.8500 $51.1500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 13 13 10.788889 $528.0100 $48.9400
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Subtotal (Total Children Is Unduplicated) 1428 1765 2055.379599 $107409.0800 $52.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 38 51 52.912710 $264564.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 2.676104 $133.8100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 18 23.234965 $1161.7500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.428571 $102.3000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 12 12 9.066210 $2085.2300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 996 1168 967.609678 $48380.7700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 69 71 44.656508 $1116.4200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2111 2400 3461.899574 $173095.0300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 222 243 288.821434 $7220.5500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1133 1335 1672.621427 $83631.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 96 143 151.043650 $3776.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 739 838 1036.567825 $51828.3900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 63 62.355560 $1558.9000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2049 2195 2454.008673 $122700.3600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 208 223 271.394444 $6784.8600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 32.288889 $2367.4200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 38 43 324.145234 $8103.6300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1673 1827 11573.805900 $578690.5500 $50.0000
INTR -T1013 INTERPRETER 199 235 781.209080 $39060.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4905 6917 34320.910136 $343209.1600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 178 186 1024.870631 $73216.7300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 46 48 257.986508 $14756.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 209 227 1058.280953 $75603.6400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 9 10 59.361904 $3393.1300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 1.610655 $104.7000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.165753 $18.9000 $114.0300
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.126027 $28.7300 $227.9500
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 5 2.155099 $982.7300 $456.0000
SENS -V5264 EARMOLD 10 10 5.626027 $101.2700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 411 440 2548.753170 $182082.9700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.533333 $144.9000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 18 18 74.928573 $1040.0000 $13.8800
TRAV -TRAVS Travel by mile 1941 3390 214313.023302 $95369.3000 $0.4500
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Subtotal (Total Children Is Unduplicated) 8513 22135 276882.078507 $2186415.0400 $7.9000
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Total 24335 281867.589049 $2379813.6100 $8.4400
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Number of Children (Unduplicated) With at Least One Authorization 9251