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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 28581 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 2 2 0.688889 $25.4900 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 249 257 349.054011 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 3.877778 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 587 591 20964.084131 $775671.1500 $37.0000
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Subtotal (Total Children Is Unduplicated) 803 852 21317.704809 $775696.6400 $36.3900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 103 111 79.621314 $3861.6600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.156164 $65.3100 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 289 289 301.919841 $7092.1000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 8 8 5.461111 $75.7500 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 21 21 11.788890 $279.4000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 6 5.233333 $47.5200 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 14 14 11.277168 $313.8400 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 3 5.000000 $192.3500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 18 18 22.155555 $1879.6700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 1.249315 $63.8100 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 19 19 19.000000 $317.3000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 2.633333 $58.9900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 14 14 11.010350 $495.4700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 9 4.201370 $483.1600 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 20 22 20.997718 $1049.8900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 415 429 711.764763 $35588.2400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 47 48 78.027397 $5852.0500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 11 11 17.510958 $1313.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 14.175342 $1063.1500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 35 46 60.653960 $4549.0300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 66 75 84.649263 $4698.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 0.008220 $0.4500 $54.6700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 371 374 592.270177 $44420.1700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 161 161 286.598928 $21494.9400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 88 88 109.121922 $8184.1100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 487 491 721.230139 $40028.2000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 277 316 532.134705 $39910.0900 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 4.899999 $245.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 12.309524 $615.4800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 44 44 13.868258 $707.9900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 6 6 10.671429 $544.7800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 38 38 24.454716 $1248.4000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 341 361 203.747395 $10401.3600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 25 26 6.488891 $331.2700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 2.044444 $104.3700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 23 23 16.320851 $833.1700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 245 260 137.759966 $7032.6900 $51.0500
SCREEN-T1023 SCREENING 50 53 53.274603 $2663.7300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.233333 $3.5000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 8 8 7.190334 $367.0600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 11 11 7.076561 $361.2600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 393 420 237.993662 $12149.5800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 7 7 5.244444 $267.7300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 56 57 58.189303 $2592.3400 $44.5500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.088889 $3.2000 $35.9800
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Subtotal (Total Children Is Unduplicated) 2643 3923 4522.207838 $264485.3500 $58.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 114 121 115.267736 $576340.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 8 8 5.049620 $252.4800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 18 18.913240 $945.6600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 3.044444 $218.0100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 15 15 15.516667 $3568.8400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 876 1058 980.927023 $49046.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 171 193 161.161579 $4029.0500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1446 1601 2173.264901 $108663.2200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 220 233 286.573019 $7164.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 814 970 1055.976963 $52798.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 84 143 155.565079 $3889.1300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 476 514 672.535718 $33626.8100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 17 29 87.650002 $2191.2600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1405 1496 1477.337754 $73866.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 199 208 244.815874 $6120.4000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 240 275 2242.419036 $56060.4900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5678 6148 38237.843143 $1911892.4000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 25.571428 $1278.5800 $50.0000
INTR -T1013 INTERPRETER 203 238 690.624737 $34531.2400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3451 4848 23084.041926 $230840.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 727 773 4104.992063 $293260.7500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.142857 $153.0900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 297 322 1636.015874 $93580.1500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 788 841 4107.030138 $293406.3200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 1.142857 $81.6500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 102 111 618.362302 $35345.6100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 1.077168 $245.5800 $227.9900
SENS -V5060 BEHIND EAR HEARING AID 3 3 3.000000 $684.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 5 4.355556 $1986.1500 $456.0000
SENS -V5264 EARMOLD 25 25 20.824047 $374.8300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1062 1168 6355.685697 $454050.3400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 22.000000 $1571.6800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 20 25 110.746033 $6334.6700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 12.000000 $857.2800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 108 114 610.166671 $8469.1100 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 3 3 0.857142 $31.7100 $37.0000
TRAV -TRAVS Travel by mile 1315 2276 131891.946842 $58691.9200 $0.4500
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Subtotal (Total Children Is Unduplicated) 7867 23806 221237.445136 $4406514.9200 $19.9200
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Total 28581 247077.357783 $5446696.9200 $22.0400
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Number of Children (Unduplicated) With at Least One Authorization 8722