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 23933 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 341 347 547.810327 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 5 16.846031 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 84 84 2952.761906 $109252.1500 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 424 438 3518.796042 $109303.1300 $31.0600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 141 155 103.998095 $5043.9000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 4.472222 $252.6300 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.005556 $0.1100 $19.8700
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 122 122 126.124603 $2962.6700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 2.350000 $32.5900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 8 5.450000 $129.1600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 13 13 11.350000 $103.0600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 14 14 12.350000 $343.7000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 0.838889 $32.2700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 5 4.377778 $371.4100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.344444 $17.5900 $51.0600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 13 13 11.350000 $189.5500 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 0.838889 $18.7900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 2.755555 $124.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.677777 $77.9400 $114.9900
EVAL -96111 DEVELOPMENTAL EVALUATION 41 49 44.431962 $2221.6000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 652 683 1116.318526 $55815.9400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.104110 $7.8100 $74.9900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 10.779453 $808.4600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 2.002740 $150.2100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.005480 $0.4100 $75.2700
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 2.052055 $153.9100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 24 26 14.501668 $804.8200 $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 97 97 86.713707 $6503.4900 $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 57 57 4.209603 $315.6500 $74.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 193 193 211.218603 $11722.5600 $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 3 3 4.299999 $215.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 9 3.700000 $188.8900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 13.264916 $677.1700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 50 51 46.632332 $2380.5700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 7 2.027778 $103.5200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 5.191781 $265.0400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 42 44 39.807880 $2032.1800 $51.0500
SCREEN-T1023 SCREENING 3 3 3.022222 $151.1100 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.222222 $3.3300 $15.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 77 78 56.421603 $2880.3200 $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 8 9 5.890944 $288.3100 $48.9400
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1444 1814 2121.619552 $109389.2200 $51.5600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 59 64 59.783867 $298920.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 0.982192 $49.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 13 13 11.987977 $599.4000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.183333 $13.1300 $71.6000
AUDE -V5160 DISPENSING FEE BINAURAL 11 11 9.633333 $2215.6600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1038 1194 1095.739969 $54787.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 75 79 50.072186 $1251.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1968 2204 3148.981596 $157449.0300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 256 272 281.645234 $7041.1200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1207 1414 1584.829271 $79241.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 106 169 190.979363 $4774.4800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 665 744 903.572207 $45178.5500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 30 49 106.579364 $2664.4800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1943 2056 2175.656298 $108782.7600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 253 261 252.349998 $6308.7500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 31 37 197.903178 $4947.5900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1564 1658 10644.492168 $532224.6500 $50.0000
INTR -T1013 INTERPRETER 196 244 821.272578 $41063.6400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5044 6979 33975.939146 $339759.3000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 140 145 783.693659 $55987.0400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 45 48 263.029367 $15045.2600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 173 187 978.729375 $69920.4000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 13 14 56.714287 $3241.8000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.444444 $93.8900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.222222 $25.3300 $113.9900
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 1.999999 $911.9500 $455.9800
SENS -V5264 EARMOLD 6 6 4.244443 $76.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 370 395 2339.695764 $167147.7500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.142857 $351.3700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 63.071429 $875.4300 $13.8800
TRAV -TRAVS Travel by mile 1763 3415 198092.176364 $88151.0300 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 8256 21681 258104.747468 $2089327.6900 $8.0900
-------------------------------------------------------------------------------------------------------------------------------------
Total 23933 263745.163062 $2308020.0400 $8.7500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 9000