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 23611 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 334 343 440.557507 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 3.877778 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 72 72 2903.319048 $107422.8300 $37.0000
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Subtotal (Total Children Is Unduplicated) 406 419 3348.443222 $107448.3100 $32.0900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 141 155 115.405636 $5597.2000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.116667 $63.0800 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.172222 $3.3900 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 205 205 213.457936 $5014.1300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.172222 $16.2600 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 3.872222 $91.7700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 11 11 10.172222 $92.3600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 11 11 10.172222 $283.0900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 4.000000 $153.8800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 6 3.350000 $284.2100 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 10 10 9.172222 $153.1800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 2.000000 $44.8000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 7 4.522223 $203.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 4.066667 $467.6700 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 24 28 27.364232 $1368.2200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 562 582 963.818035 $48190.9000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 2.931507 $219.8600 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 17 14.045204 $1053.3900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 2.179452 $163.4600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 14 12.279454 $920.9400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 51 52 25.764386 $1429.9100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 0.002740 $0.1500 $54.6700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 96 99 79.756167 $5981.7000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 25 25 40.302153 $3022.6600 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 35 35 18.109593 $1358.2100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 145 145 149.652834 $8305.7300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 56 59 92.032879 $6902.4500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.002740 $0.2000 $73.9100
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
OCTF -97168 OT RE-EVAL EST PLAN CARE 6 6 0.977778 $49.9200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 9.942488 $507.5600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 63 66 59.644302 $3044.8400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 4 0.533333 $27.2200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 4.272222 $218.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 43 44 20.933180 $1068.6400 $51.0500
SCREEN-T1023 SCREENING 9 9 8.711111 $435.5600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.788889 $11.8300 $15.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 82 86 62.437779 $3187.4500 $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 18 18 13.358219 $595.1100 $44.5500
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Subtotal (Total Children Is Unduplicated) 1422 1747 2011.546952 $101589.5800 $50.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 59 65 81.494979 $407475.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 1.705176 $85.2600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 11 11 9.773516 $488.6800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.277778 $91.5000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 13 13 10.877778 $2501.8900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1094 1308 1183.431531 $59171.8100 $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 150 166 140.679326 $3517.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1977 2191 2989.121163 $149456.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 273 293 339.776393 $8494.4200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1200 1413 1547.671009 $77383.5800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 107 182 190.581746 $4764.5500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 668 734 954.611012 $47730.6000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 27 50 108.705554 $2717.6400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2068 2211 2246.578637 $112328.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 252 263 294.522224 $7363.0600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 17 17 108.684128 $2717.1000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1598 1732 10838.248379 $541912.4800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 7.428572 $371.4300 $50.0000
INTR -T1013 INTERPRETER 231 268 806.268312 $40313.4100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4739 6680 32128.420471 $321284.2200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 142 151 793.338094 $56676.1000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 57 62 319.090475 $18251.9700 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.857143 $61.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 187 198 967.826190 $69141.5500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 21.499999 $1228.9500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.577778 $102.5600 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.788889 $89.9300 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 0.924201 $421.4400 $456.0000
SENS -V5264 EARMOLD 9 10 6.327778 $113.9000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 353 371 2140.220956 $152897.4400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 28.285714 $1617.9400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 15 16 114.776193 $1593.0900 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 3 3 1.071428 $39.6400 $37.0000
TRAV -TRAVS Travel by mile 1747 3011 166560.111261 $74119.2500 $0.4500
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Subtotal (Total Children Is Unduplicated) 8174 21445 224950.053783 $2167233.1300 $9.6300
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Total 23611 230310.043957 $2376271.0200 $10.3200
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Number of Children (Unduplicated) With at Least One Authorization 8923