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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 14842 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 1 1 0.811111 $30.0100 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 275 285 337.109281 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 1.466667 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 19 21 480.000000 $17760.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 297 309 819.387059 $17790.0100 $21.7100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 89 103 66.287214 $3214.9300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 101 101 107.279365 $2519.9900 $23.4900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.000000 $76.9400 $38.4700
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 27 34 18.179220 $908.9600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 412 427 661.898416 $33094.9100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.052740 $3.9500 $74.9400
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 0.122603 $6.8000 $55.4500
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 18 18 33.005479 $2475.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 16.005479 $1200.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 6.008219 $450.6200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 32 34 57.024657 $3164.8700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 19.502740 $1462.7000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 1.500000 $75.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 1.933334 $96.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.361111 $18.4300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 15 15 10.165875 $518.9700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.544444 $27.7900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 8 9 4.222070 $215.5400 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 22 9.344260 $477.0200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 9.428571 $461.4400 $48.9400
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.366667 $18.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 718 816 1033.695879 $50943.4200 $49.2800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 21 20.683333 $103416.5000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 10 10 9.477778 $473.8900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 4.877778 $1121.8900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 674 796 735.956400 $36798.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 36 36 26.903903 $672.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1411 1557 2164.028844 $108201.4700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 171 186 223.976192 $5599.4100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 741 877 992.640064 $49631.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 67 109 133.933334 $3348.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 499 563 622.746481 $31137.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 28 45 54.823811 $1370.6000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1332 1406 1490.841279 $74542.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 163 174 198.694448 $4967.3700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.285714 $240.9100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 8 35.799998 $895.0100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 240 255 1382.749198 $69137.4900 $50.0000
INTR -T1013 INTERPRETER 199 225 700.837375 $35041.8800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3488 4791 22891.268690 $228912.7500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 30 30 160.238097 $11447.4000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 16 16 80.314285 $4593.9800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 63 64 269.599205 $19260.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 16.000000 $914.5600 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -V5264 EARMOLD 3 3 2.777778 $50.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 64 69 343.026842 $24505.8400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 38.571428 $535.3700 $13.8800
TRAV -TRAVS Travel by mile 1427 2464 150753.138654 $67085.1500 $0.4500
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Subtotal (Total Children Is Unduplicated) 5456 13717 183358.190909 $883901.9000 $4.8200
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Total 14842 185211.273847 $952635.3400 $5.1400
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Number of Children (Unduplicated) With at Least One Authorization 5900