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 15253 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 240 248 305.841637 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 3.877778 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 18 18 373.638094 $13824.6200 $37.0000
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Subtotal (Total Children Is Unduplicated) 261 270 684.046398 $13850.1100 $20.2500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 99 106 76.432424 $3707.0000 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 181 181 188.285714 $4422.8300 $23.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.083333 $1.9700 $23.6900
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 4.000000 $153.8800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.255556 $144.3900 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 20 22 20.997718 $1049.8900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 403 416 688.764763 $34438.2400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 4 4.010958 $300.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.175342 $13.1500 $74.9800
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 6 5.268494 $395.1300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 10 4.272603 $237.1200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 16 16 25.012329 $1875.9200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 6.006850 $450.5100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 29 29 40.042463 $2222.3600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 15 16 31.000000 $2325.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 4.899999 $245.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 6.142857 $307.1500 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.366667 $18.7200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 13 14 8.903608 $454.5300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 14 14 7.360958 $375.7700 $51.0500
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 23 24 10.775450 $550.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $133.6500 $44.5500
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Subtotal (Total Children Is Unduplicated) 808 892 1159.063565 $55307.5800 $47.7200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 20 22 38.900000 $194500.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 1.038509 $51.9300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 2.946575 $147.3300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 797 964 867.424914 $43371.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 104 114 98.822608 $2470.5700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1431 1586 2158.987124 $107949.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 220 233 286.573019 $7164.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 809 965 1050.943629 $52547.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 84 143 155.565079 $3889.1300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 462 500 660.569053 $33028.4800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 17 29 87.650002 $2191.2600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1395 1486 1469.659977 $73483.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 198 207 243.815874 $6095.4000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 261 287 1731.665076 $86583.3100 $50.0000
INTR -T1013 INTERPRETER 201 236 687.624737 $34381.2400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3449 4845 23056.756212 $230567.5800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 28 28 157.778572 $11271.7200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 16 17 79.569047 $4551.3400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 52 53 235.972224 $16857.8500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 11.571428 $661.4300 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 4 4 3.255556 $58.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 71 74 417.998414 $29861.8300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 9.571429 $547.4800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 6 7 46.704763 $648.2600 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 0.571428 $21.1400 $37.0000
TRAV -TRAVS Travel by mile 1314 2274 131541.803985 $58536.1100 $0.4500
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Subtotal (Total Children Is Unduplicated) 5433 14091 165107.739234 $1002196.8700 $6.0700
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Total 15253 166950.849197 $1071354.5500 $6.4200
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Number of Children (Unduplicated) With at Least One Authorization 5912