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
Eligibility Filter: Program Patients
With the filters selected there were 40932 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 351 360 495.250834 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 7.020635 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 768 773 27291.731758 $1009794.1200 $37.0000
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Subtotal (Total Children Is Unduplicated) 1078 1138 27794.692116 $1009819.6100 $36.3300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 159 174 130.181589 $6313.8400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 20 20 21.894293 $1236.8100 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 2.172222 $42.8100 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 400 400 426.034127 $10007.5400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 20 20 14.555327 $201.8800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 37 37 27.383335 $648.9900 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 27 27 22.060882 $200.3100 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.366667 $3.6500 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 35 35 27.442617 $763.7200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 5 7.000000 $269.2900 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 32 33 30.794444 $2612.6000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 5 5 2.349315 $119.9800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 36 36 33.400000 $557.7800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 10 8.349771 $187.0300 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 27 28 21.965906 $988.4700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 21 21 16.807001 $1932.8100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 28 33 35.542010 $1777.1100 $50.0000
EXIT -EXIT EXIT ASSESSMENT 583 605 1003.818035 $50190.9000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 4.431507 $332.3600 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 67 68 100.561643 $7542.1100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 13 21.510958 $1613.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 16.179452 $1213.4600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 52 68 90.249851 $6768.7100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 114 126 123.141046 $6834.2900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 0.010960 $0.6000 $54.6700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 562 568 851.541410 $63865.5100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 233 233 417.906560 $31343.0100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 138 139 155.241102 $11643.0400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 693 698 998.340510 $55407.8200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 393 447 745.304766 $55897.8200 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 4.002740 $300.2000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 5 10.042856 $502.1400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 8 24.923810 $1246.2000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 61 61 20.169052 $1029.6500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 10 10 14.671429 $748.9800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 65 66 48.681297 $2485.1700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 525 551 342.784184 $17499.1600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 49 50 11.300003 $576.8800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 3.483333 $177.8200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 34 34 24.398629 $1245.5400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 344 363 187.895223 $9592.1100 $51.0500
SCREEN-T1023 SCREENING 74 78 78.985714 $3949.2900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 5 9.536508 $143.0500 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 14 14 12.551445 $640.7500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 18 18 14.076561 $718.6100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 616 650 384.145358 $19610.6200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 12 12 9.366666 $478.1700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 91 92 83.006352 $3697.9400 $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) 3934 5901 6644.652834 $385385.3600 $58.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 182 196 204.918424 $1024594.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 16 17 14.605176 $730.2600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 40 40 41.847008 $2092.3500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 9 8.494444 $608.2800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 38 38 34.684421 $7977.4100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1232 1475 1374.385539 $68719.5200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 0.500000 $25.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 252 288 245.655936 $6141.4100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1998 2212 3007.710052 $150385.5000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 273 293 339.776393 $8494.4200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1207 1420 1554.704343 $77735.2500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 107 182 190.581746 $4764.5500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 689 755 970.861011 $48543.0900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 27 50 108.705554 $2717.6400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2090 2234 2263.805622 $113190.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 253 264 295.522224 $7388.0600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 298 333 3094.388878 $77359.7300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7676 8343 51938.424063 $2596921.4300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 9 33.000000 $1650.0000 $50.0000
INTR -T1013 INTERPRETER 238 275 828.054026 $41402.7000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4742 6685 32170.420470 $321704.2200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1185 1270 6742.517211 $481685.5900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 10.500000 $750.1300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 408 439 2283.071825 $130591.7500 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.857143 $61.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1220 1311 6488.653581 $463549.5900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 3 6.838095 $488.5200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 130 143 751.533731 $42957.6800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 2.758600 $179.3100 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.969711 $110.5500 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 9 9 5.455250 $1243.7900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 6 6 7.600000 $1732.8000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 13 13 9.927246 $4526.8500 $456.0000
SENS -V5264 EARMOLD 54 55 43.148249 $776.6700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2116 2303 12992.494743 $928184.0900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 9 39.428572 $2816.7700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 25 30 135.712699 $7762.7700 $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 147 156 883.157147 $12258.2200 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 4 4 1.357142 $50.2100 $37.0000
TRAV -TRAVS Travel by mile 1748 3013 166910.254118 $74275.0700 $0.4500
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Subtotal (Total Children Is Unduplicated) 11292 33893 296049.280393 $6718004.4800 $22.6900
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Total 40932 330488.625343 $8113209.4500 $24.5500
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Number of Children (Unduplicated) With at Least One Authorization 12558