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 23063 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 339 349 378.612324 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 10.609524 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 73 75 1839.761908 $68071.2100 $37.0000
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Subtotal (Total Children Is Unduplicated) 415 428 2229.794867 $68101.2200 $30.5400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 123 139 88.641245 $4299.1000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 2.238889 $126.4800 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 1.494445 $29.4600 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 138 138 159.207143 $3739.7700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 8 8 5.022223 $69.6600 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 8 4.622223 $109.5500 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 9 5.052360 $45.8800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 10 10 7.022223 $195.4300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 5 3.927778 $151.1000 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 9 6.185693 $524.7900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 1.513470 $77.2900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 10 10 7.066667 $118.0100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 2.957915 $66.2600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.622222 $73.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.477778 $54.9500 $115.0100
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 31 39 20.406921 $1020.3500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 590 614 957.679727 $47883.9800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 7 4.416437 $331.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 13 4.108296 $308.1300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 2.004110 $150.3100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 0.106850 $8.0100 $74.9600
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 6 4.058220 $304.3600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 34 34 22.061552 $1224.3800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 110 110 101.247953 $7593.5700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 43 43 70.035616 $5252.6700 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 56 56 14.200012 $1064.9600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 184 186 204.531121 $11351.4600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 87 93 132.086307 $9906.4200 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 1.500000 $75.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 3.366667 $168.3400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 7 7 1.750000 $89.3400 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 4.779376 $243.9800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 50 51 33.722573 $1721.5500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 10 10 3.899999 $199.0900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.405555 $20.7000 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.300229 $15.3300 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 47 50 30.866535 $1575.7300 $51.0500
SCREEN-T1023 SCREENING 10 10 7.055555 $352.7800 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.021918 $1.1200 $51.0100
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 2.361111 $120.5300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 75 79 34.285739 $1750.3000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.050000 $2.5500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 7 13.428571 $657.2000 $48.9400
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.366667 $18.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 1387 1800 1975.441605 $103252.6300 $52.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 48 54 51.977853 $259889.0000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.477778 $23.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 13 13 13.050001 $652.5100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 10 10 7.977778 $1834.8900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 944 1102 978.686268 $48934.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 56 56 38.972550 $974.3200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1973 2174 3065.516139 $153275.8100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 222 239 273.637304 $6840.9400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1119 1306 1582.100376 $79104.9100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 86 141 172.016664 $4300.4100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 711 795 902.008175 $45100.4000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 57 65.701587 $1642.5400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2000 2127 2309.032267 $115451.6500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 216 229 255.776194 $6394.4100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 4.507936 $330.5200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 34 45 211.965075 $5299.1300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1574 1656 10094.984053 $504749.3900 $50.0000
INTR -T1013 INTERPRETER 232 259 807.683852 $40384.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4766 6557 31305.600884 $313056.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 132 137 697.942860 $49861.0100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 44 44 238.179367 $13623.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 187 197 936.492460 $66903.0300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 10 10 69.100000 $3949.7500 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 1.217808 $555.3200 $456.0000
SENS -V5264 EARMOLD 8 8 5.655556 $101.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 313 342 1870.835558 $133652.6000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 13 13 94.857145 $1316.6200 $13.8800
TRAV -TRAVS Travel by mile 1906 3256 188383.239715 $83830.5400 $0.4500
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Subtotal (Total Children Is Unduplicated) 8208 20835 244440.193203 $1942034.1000 $7.9400
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Total 23063 248645.429675 $2113387.9500 $8.5000
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Number of Children (Unduplicated) With at Least One Authorization 8947