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: 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 40292 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 0.800000 $29.6000 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 330 331 505.283368 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 12.285714 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 863 867 32087.276977 $1187229.3000 $37.0000
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Subtotal (Total Children Is Unduplicated) 1145 1201 32605.646059 $1187258.9000 $36.4100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 135 153 114.312635 $5544.1900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 29 29 41.661111 $2353.4400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 4 1.561111 $30.7700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 437 441 457.217277 $10740.0300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 16 17 12.838889 $178.0800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 40 41 24.927779 $590.7900 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 23 24 18.676789 $169.5900 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 26 27 19.910198 $554.1000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 5 4.111111 $158.1500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 29 29 28.625039 $2428.5600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 8 8 5.569863 $284.4500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 26 27 21.350381 $356.5500 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 11 12 8.508371 $190.5900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 23 23 39.434322 $1774.5400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 12 7.847031 $902.3900 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 31 39 20.146648 $1007.3400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 549 566 906.581433 $45329.0700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 6 2.783561 $208.7700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 64 64 82.102971 $6157.7000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 20 20 28.034551 $2102.5900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 9.023289 $676.7400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 56 73 110.518877 $8288.8900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 93 94 95.568026 $5303.9600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 713 714 1161.456175 $87109.1000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 311 313 564.126021 $42309.4700 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 233 233 217.983583 $16348.6700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 925 934 1402.985913 $77865.6400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 539 605 951.557342 $71366.7200 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 4 20.000000 $1000.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 9 9 38.142857 $1907.1500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 66 67 16.964608 $866.0200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 16.683333 $851.6800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 80 80 52.214230 $2665.5200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 499 512 300.295936 $15330.1100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 49 52 15.709057 $801.9500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 4.416667 $225.4700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 35 35 49.064283 $2504.7200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 322 338 200.158808 $10218.1000 $51.0500
SCREEN-T1023 SCREENING 76 79 77.167460 $3858.3800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 3.622223 $54.3300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 18 18 20.974603 $1070.7500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 19 20 16.475722 $841.0800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 626 657 368.678858 $18821.1100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 12 12 9.417656 $480.7700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 59 59 52.086312 $2549.1100 $48.9400
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Subtotal (Total Children Is Unduplicated) 4087 6483 7621.492910 $454377.1300 $59.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 145 162 179.344997 $896725.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 12 11.783332 $589.1600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 38 40 34.460275 $1723.0300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 8 8 13.722222 $982.6500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 27 28 28.849620 $6635.4300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1104 1278 1175.571613 $58778.8500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 135 138 128.868757 $3221.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1951 2129 3334.469782 $166723.3700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 259 270 300.034916 $7500.8600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1213 1400 1746.356319 $87317.6600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 101 165 174.218268 $4355.4900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 694 754 1023.686098 $51184.2400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 30 50 60.927780 $1523.2000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2127 2212 2535.247604 $126762.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 249 256 263.550000 $6588.7500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 267 300 2882.707943 $72067.7000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7620 8054 55093.596834 $2754680.0000 $50.0000
INTR -T1013 INTERPRETER 234 274 807.983856 $40399.1700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4840 6459 34485.323375 $344853.2100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1123 1177 6774.247475 $483952.1300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 446 472 2668.474609 $152636.7000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1196 1270 7084.097213 $506087.9500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 148 154 934.817386 $53434.1500 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.052055 $3.3900 $65.0600
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 1.463013 $333.5400 $227.9800
SENS -V5060 BEHIND EAR HEARING AID 3 3 4.377778 $998.1400 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 8 8 9.123136 $4160.1300 $456.0000
SENS -V5264 EARMOLD 43 43 38.289649 $689.2100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2015 2164 13365.099856 $954802.6300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 12 99.274603 $5678.5000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 179 184 1215.754764 $16874.6700 $13.8800
TRAV -TRAVS Travel by mile 1674 3124 174105.460521 $77476.9300 $0.4500
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Subtotal (Total Children Is Unduplicated) 11103 32608 310582.235649 $6889739.8500 $22.1800
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Total 40292 350809.374618 $8531375.8800 $24.3200
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Number of Children (Unduplicated) With at Least One Authorization 12071