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: 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 14665 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 0.833333 $30.8300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 214 217 305.017461 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 7 7 467.966667 $17314.7700 $37.0000
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Subtotal (Total Children Is Unduplicated) 222 225 773.817461 $17345.6000 $22.4200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 94 109 106.044066 $5143.1400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 209 209 220.857143 $5187.9300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
EVAL -96111 DEVELOPMENTAL EVALUATION 20 22 21.804948 $1090.2600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 441 448 697.672452 $34883.6400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 3 1.010958 $75.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.175342 $163.1500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 5 5.005480 $375.4100 $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
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 7.000000 $357.3500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 10 11 7.027778 $358.7700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.272222 $13.9000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 11 5.888889 $300.6300 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.505556 $25.8100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 17 20 9.621386 $491.1800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $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) 847 938 1217.225944 $57197.2400 $46.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 19 27.956469 $139782.0000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.455556 $22.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 6 6.566666 $328.3300 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 789 920 860.226984 $43011.5400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 106 116 105.272836 $2631.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1255 1375 2099.404658 $104970.2800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 11 11 3.923809 $196.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 188 202 224.122229 $5603.0600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 824 946 1135.068263 $56753.3500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.919047 $45.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 70 120 124.197228 $3104.9500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 507 550 730.968647 $36548.4100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 5 5 1.733333 $86.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 20 34 28.055556 $701.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1338 1414 1542.696410 $77134.7400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 6 6 1.277777 $63.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 186 198 216.579372 $5414.4900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 13.577778 $339.4500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 7.276190 $363.8100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 255 277 1865.676191 $93283.8300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 13 13 24.395239 $1219.7700 $50.0000
INTR -T1013 INTERPRETER 195 237 802.951715 $40147.6000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3453 4677 24065.212622 $240652.1300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 21 22 142.719048 $10195.8500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 4.000000 $285.7600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 21 23 114.500001 $6549.3900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 37 41 187.245239 $13376.8300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 43.750000 $2500.7500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.677778 $309.0800 $456.0100
SENS -V5264 EARMOLD 5 5 4.677778 $84.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 57 60 333.069844 $23794.5100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 2.000000 $142.8800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 47.500001 $659.3000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 58 71 56.019047 $2072.7300 $37.0000
TRAV -TRAVS Travel by mile 1142 2128 119779.719027 $53301.9800 $0.4500
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Subtotal (Total Children Is Unduplicated) 5299 13502 154607.392338 $966204.6300 $6.2500
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Total 14665 156598.435743 $1040747.4800 $6.6500
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Number of Children (Unduplicated) With at Least One Authorization 5804