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 23040 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 319 320 491.042577 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 2.285714 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 82 82 3037.733330 $112396.1500 $37.0000
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Subtotal (Total Children Is Unduplicated) 400 404 3531.861621 $112425.7500 $31.8300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 119 133 98.886455 $4796.0100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 6.272222 $354.3200 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 3 0.561111 $11.0600 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 280 284 291.051587 $6836.8000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 6 3.194444 $44.3100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 4 2.111111 $50.0300 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 7 3.391704 $30.8000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 8 5.194444 $144.5600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 4 3.111111 $119.6800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 5 3.158371 $267.9600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.197260 $10.0800 $51.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 6 2.566666 $42.8600 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 7 3.669482 $82.2000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 8 29.725037 $1337.6300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 2.064078 $237.3500 $114.9900
EVAL -96111 DEVELOPMENTAL EVALUATION 28 36 17.141092 $857.0600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 535 552 881.581433 $44079.0700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 0.783561 $58.7700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 16 12.042543 $903.2000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 6.004110 $450.3100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 2.008220 $150.6200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 6 4.090412 $306.7700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 37 38 38.082786 $2113.5600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 111 111 103.247953 $7743.5700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 44 44 71.035616 $5327.6700 $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 188 190 211.531121 $11739.9600 $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 3 4 20.000000 $1000.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 8.509524 $425.4800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 7 7 1.666667 $85.0900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.116667 $5.9600 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 12 5.959893 $304.2500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 72 73 41.596347 $2123.5000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 12 4.216668 $215.2700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.961111 $49.0600 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 0.761567 $38.8700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 44 46 25.022222 $1277.3800 $51.0500
SCREEN-T1023 SCREENING 12 12 13.367459 $668.3700 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.116667 $5.9600 $51.0600
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 4.361111 $222.6300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 89 92 42.498019 $2169.5100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.128767 $6.5800 $51.0600
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 8 7.155556 $350.2000 $48.9400
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Subtotal (Total Children Is Unduplicated) 1506 1924 2125.428494 $108015.6600 $50.8200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 40 46 54.596347 $272982.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.488888 $74.4400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 13 14 9.763927 $488.2000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.166667 $83.5500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 5.177778 $1190.8900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 961 1102 961.835589 $48092.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 54 55 59.813439 $1495.3400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1935 2112 3315.824545 $165791.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 259 270 300.034916 $7500.8600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1200 1385 1730.694415 $86534.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 101 165 174.218268 $4355.4900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 669 729 1005.430543 $50271.4700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 30 50 60.927780 $1523.2000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2114 2197 2517.536493 $125876.7700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 249 256 263.550000 $6588.7500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 18 23 132.447619 $3311.1900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1550 1644 11530.044430 $576502.3600 $50.0000
INTR -T1013 INTERPRETER 219 255 767.483855 $38374.1800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4840 6458 34481.037661 $344810.3600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 152 159 1036.920639 $74077.6200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 51 54 300.995238 $17216.9000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 189 199 1086.796425 $77640.7100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 7 47.000000 $2686.5300 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 0.586301 $133.6500 $227.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 3.012025 $1373.4700 $456.0000
SENS -V5264 EARMOLD 10 10 5.836300 $105.0500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 334 358 2255.267063 $161116.2800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 31.285714 $1789.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 21 21 191.495239 $2657.9500 $13.8800
TRAV -TRAVS Travel by mile 1673 3122 174093.174807 $77471.4600 $0.4500
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Subtotal (Total Children Is Unduplicated) 8061 20712 236426.442911 $2152115.9300 $9.1000
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Total 23040 242083.733026 $2372557.3400 $9.8000
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Number of Children (Unduplicated) With at Least One Authorization 8870