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
Eligibility Filter: Program Patients
With the filters selected there were 40556 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 351 361 385.061531 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 10.609524 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 842 876 27076.961911 $1001847.7100 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1146 1241 27473.444077 $1001877.7200 $36.4700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 143 165 110.742235 $5371.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 15 16 24.218971 $1368.1300 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 10 10 10.634171 $209.6000 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 411 413 457.547749 $10747.8000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 31 29.030139 $402.6500 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 53 53 42.069840 $997.0500 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 28 29 22.055024 $200.2600 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.450000 $4.4800 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 47 48 55.412004 $1542.1200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 9 9 8.927778 $343.4500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 40 40 41.810425 $3547.1900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 15 15 11.235692 $573.8000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 34 35 27.747870 $463.3900 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 18 19 15.053882 $337.2100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 27 28 20.378766 $917.0400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 21 22 19.320341 $2221.8300 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 33 41 22.412477 $1120.6300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 608 633 991.108298 $49555.4100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 10 12 11.416437 $856.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 54 54 59.268724 $4445.1400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 19 19 24.134551 $1810.0900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 7.121919 $534.1400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 55 72 107.406167 $8055.4400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 87 87 73.819698 $4096.9300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 712 713 1159.956175 $86996.6000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 311 313 565.126021 $42384.4700 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 234 234 219.983583 $16498.6700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 918 927 1386.826812 $76968.8200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 535 601 948.051862 $71103.8100 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 4.928571 $246.4300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 6 11.504763 $575.2400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 65 71 15.799998 $806.5800 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 5.411111 $276.2400 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 63 64 39.127320 $1997.4400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 435 449 264.266505 $13490.8000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 56 56 11.104035 $566.8700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 9 9 3.761111 $192.0000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 26 26 16.148250 $824.3700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 342 361 188.408426 $9618.2500 $51.0500
SCREEN-T1023 SCREENING 67 67 60.300000 $3015.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 15 15 16.725885 $853.8500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 16 16 12.768265 $651.8200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 558 583 295.559776 $15088.3300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 10 10 7.805555 $398.4700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 43 43 73.098411 $3577.4400 $48.9400
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 1 1 1.000000 $75.7200 $75.7200
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.366667 $18.3400 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 4183 6443 7504.637974 $446106.7500 $59.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 165 189 151.026469 $755131.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 13 13 9.316668 $465.8400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 38 39 38.417952 $1920.9100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.450000 $32.2200 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 8 8 9.272070 $663.9800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 60 60 57.832115 $13301.3800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1104 1295 1215.407810 $60770.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 142 144 108.178944 $2704.4800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2003 2208 3092.984392 $154649.2200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 222 239 273.637304 $6840.9400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1147 1337 1611.634503 $80581.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 86 141 172.016664 $4300.4100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 732 817 923.953412 $46197.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 57 65.701587 $1642.5400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2031 2158 2332.743377 $116637.2000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 216 229 255.776194 $6394.4100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 9 9 13.698412 $1004.3600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 351 415 5141.369820 $128534.2600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7485 7984 48296.743756 $2414837.8500 $50.0000
INTR -T1013 INTERPRETER 250 280 874.574328 $43728.7300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4766 6558 31317.743741 $313177.5100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1095 1164 6011.019645 $429427.2700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 373 409 2111.281746 $120765.3400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1190 1265 6217.861777 $444204.1900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 156 167 920.232536 $52600.5700 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.164384 $10.6900 $65.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 12 12 4.736986 $1080.0400 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 10 10 10.773364 $4912.6700 $456.0000
SENS -V5264 EARMOLD 49 49 39.395588 $709.1200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2032 2195 12040.307365 $860159.8100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.428571 $81.7200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 145 157 791.206344 $10981.9400 $13.8800
TRAV -TRAVS Travel by mile 1908 3259 188388.811144 $83833.0200 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 11265 32872 312501.698968 $6162512.0300 $19.7200
-------------------------------------------------------------------------------------------------------------------------------------
Total 40556 347479.781019 $7610496.5000 $21.9000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 12808