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: 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 41946 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
CASE -CASE NON-TCM CASE MANAGEMENT 2 2 1.377778 $50.9800 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 359 366 568.786517 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 5 16.846031 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 884 901 31449.463483 $1163629.7900 $37.0000
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Subtotal (Total Children Is Unduplicated) 1182 1274 32036.473809 $1163680.7700 $36.3200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 164 181 127.596269 $6188.4100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 22 22 22.000989 $1242.8300 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 2.005556 $39.5300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 321 321 346.001587 $8127.5800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 20 20 14.127625 $195.9500 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 40 42 31.938890 $756.9500 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 27 28 23.038737 $209.1900 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.138889 $1.3800 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 41 42 37.219036 $1035.8100 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 2.838889 $109.2100 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 24 25 25.166668 $2135.1500 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 2.350000 $120.0100 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 34 35 33.350000 $556.9500 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 11 11 8.072070 $180.8200 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 26 28 24.605708 $1107.2600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 17 19 13.209816 $1519.1000 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 44 53 48.742313 $2437.1200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 665 699 1142.318526 $57115.9400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 9 10.312329 $773.4200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 52 52 80.304263 $6022.8200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 20 20 28.030288 $2102.2800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 13 13.017810 $976.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 50 72 86.615983 $6496.1900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 72 81 84.255778 $4676.1600 $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 680 682 1106.022318 $82951.5800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 316 316 568.922693 $42669.2200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 177 177 127.415096 $9555.9900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 881 895 1328.106264 $73709.8200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 588 678 1057.604500 $79320.3300 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 16.157142 $807.8500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 9 39.666668 $1983.3400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 86 91 26.557944 $1355.8200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 4.416667 $225.4700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 61 62 54.257545 $2769.8600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 459 485 289.729135 $14790.6500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 48 50 12.122226 $618.8600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 7 7 4.983334 $254.4000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 30 31 27.635845 $1410.8100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 351 385 221.401549 $11302.5400 $51.0500
SCREEN-T1023 SCREENING 37 37 34.623809 $1731.1900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 5 4.941269 $74.1200 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 16 16 11.883942 $606.6800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 24 24 20.424353 $1042.6600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 536 565 292.399853 $14927.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 10 10 7.716667 $393.9400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 39 42 35.485173 $1736.6500 $48.9400
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.355556 $12.7900 $35.9800
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 1 1 0.866667 $65.6300 $75.7200
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
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Subtotal (Total Children Is Unduplicated) 3960 6367 7503.959790 $448677.2000 $59.7900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 190 212 178.956773 $894784.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 13 13 12.948859 $647.4400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 36 38 33.245912 $1662.2900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 10 10 7.138890 $511.2200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 43 44 53.252055 $12247.9800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1203 1398 1350.057651 $67503.1800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 168 177 132.980736 $3324.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2002 2242 3188.759374 $159437.9200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 259 275 285.211901 $7130.2900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1220 1427 1596.790383 $79839.4100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 106 169 190.979363 $4774.4800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 688 767 921.653954 $46082.6500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 30 49 106.579364 $2664.4800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1977 2091 2216.229315 $110811.4100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 253 261 252.349998 $6308.7500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 464 575 5305.734945 $132643.4400 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 4.000000 $200.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7695 8248 51310.869661 $2565543.1500 $50.0000
INTR -T1013 INTERPRETER 225 280 890.629721 $44531.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5045 6982 33997.796289 $339977.8700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1133 1211 6008.550406 $429250.5300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 372 432 2194.153603 $125505.5000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1162 1239 6453.937701 $461068.9600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 161 197 1007.103191 $57566.0100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 3.912937 $254.3400 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 3 0.990715 $112.9400 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 5 6 3.159817 $720.4100 $227.9900
SENS -V5060 BEHIND EAR HEARING AID 5 5 5.000000 $1140.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 14 15 12.451826 $5678.0200 $456.0000
SENS -V5264 EARMOLD 42 46 33.226938 $598.0800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2086 2249 13129.601155 $937978.0800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 28.772223 $1645.7800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 172 215 1036.361923 $14384.6900 $13.8800
TRAV -TRAVS Travel by mile 1764 3418 198473.462079 $88320.7000 $0.4500
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Subtotal (Total Children Is Unduplicated) 11377 34305 330426.849658 $6604850.5200 $19.9900
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Total 41946 369967.283257 $8217208.5000 $22.2100
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Number of Children (Unduplicated) With at Least One Authorization 12286