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
Eligibility Filter: Program Patients
With the filters selected there were 39893 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 304 307 517.146824 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 164 165 12229.158728 $452478.8800 $37.0000
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Subtotal (Total Children Is Unduplicated) 460 473 12747.138885 $452509.7100 $35.5000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 150 171 157.694599 $7648.2000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 25 25 27.683713 $1563.8500 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 2.083333 $41.0600 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 359 359 371.708730 $8731.4400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 18 18 15.066210 $208.9700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 35 35 20.283333 $480.7100 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 22 22 16.181289 $146.9300 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $9.9600 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 28 29 36.540814 $1016.9300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 3.000000 $115.4100 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 26 28 22.183333 $1882.0300 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 9 9 8.458752 $431.9900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 28 30 25.655555 $428.4500 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 14 14 12.266210 $274.7600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 23 23 13.542086 $609.4000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 18 19 8.405707 $966.6400 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 29 34 38.349240 $1917.4800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 625 635 1025.060428 $51253.0300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 7.960274 $597.0200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 62 63 89.561643 $6717.1100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 12 12 19.510958 $1463.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 24.179452 $1813.4600 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 51 67 89.394523 $6704.5700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 110 122 117.347363 $6512.7300 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 6 4.010960 $222.6000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 564 570 855.541410 $64165.5100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 235 235 420.257245 $31519.3100 $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 692 698 1004.222115 $55734.2500 $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 388 440 735.468694 $55160.1200 $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 2 2 9.857143 $492.8600 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 10 26.325396 $1316.2600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 55 57 26.522396 $1353.9700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 4.422222 $225.7500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 71 72 51.223134 $2614.9400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 514 534 363.697900 $18566.7600 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.116667 $5.9600 $51.0600
PSTF -97164 PT RE-EVAL EST PLAN CARE 41 44 13.494446 $688.9000 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.1000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 33 33 27.071940 $1382.0300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 315 337 188.842664 $9640.4500 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 81 83 82.322222 $4116.1100 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 5 13.290020 $199.3500 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 15 16 14.033484 $716.4000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 18 18 15.957839 $814.6500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 620 655 402.389634 $20542.0200 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.183333 $9.3600 $51.0400
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.466667 $23.8300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 17 17 17.208219 $878.4800 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.027778 $1.4200 $51.0900
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 126 131 136.056198 $6061.3000 $44.5500
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Subtotal (Total Children Is Unduplicated) 3791 5865 6739.376592 $390759.8600 $57.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 140 154 144.840794 $724205.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 11 7.955556 $397.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 38 38 49.248129 $2462.4100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 4.666667 $334.1800 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 7.336509 $525.3700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 43 43 46.687520 $10738.1500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1225 1432 1364.911649 $68245.8900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 2 0.900000 $45.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 261 298 249.673179 $6241.8400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1779 1949 2967.552893 $148377.6600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 17 17 7.512698 $375.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 249 270 288.111316 $7202.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1228 1406 1615.397040 $80769.8100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.919047 $45.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 101 170 168.713894 $4217.8600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 723 784 1121.910600 $56095.5100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 9 9 2.800001 $140.0100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 28 49 40.544445 $1013.6100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2052 2181 2432.819817 $121640.8600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 12 12 2.822222 $141.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 246 260 270.823022 $6770.5800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 235 249 2809.488894 $70237.2300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 7.276190 $363.8100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7406 7942 52265.038918 $2613251.9700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 380 384 874.887298 $43744.4100 $50.0000
INTR -T1013 INTERPRETER 226 272 901.709574 $45085.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4807 6536 33718.587212 $337185.8500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1094 1164 6807.940489 $486359.1800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 72 74 168.071430 $12007.0400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 476 504 2911.146041 $166517.5100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 24 24 59.142857 $3382.9700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.571429 $40.8200 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 6.142857 $438.8400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1196 1296 7081.208737 $505881.5500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 61 62 106.352380 $7597.8500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 119 124 725.052381 $41444.0000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 5 3.657143 $209.0500 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 5.428571 $387.8200 $71.4400
PHY -97110TLHM PT SESSION BY PT ASST 1 1 1.714286 $97.9900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 2.677321 $174.0200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.455099 $165.8800 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 11 12 8.214535 $1872.8800 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.433333 $326.7900 $227.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 13 13 19.477779 $8881.9200 $456.0000
SENS -V5264 EARMOLD 56 57 58.864221 $1059.5600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2226 2407 14839.019433 $1060099.5100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 137 143 237.576189 $16972.5100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 48 51 280.642858 $16052.7700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 7 7 55.285714 $3949.6100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 11 11 13.642856 $974.6600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 112 118 729.916673 $10131.2300 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.357143 $4.9600 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 92 111 98.233333 $3634.6700 $37.0000
TRAV -TRAVS Travel by mile 1559 2876 152538.300106 $67879.5400 $0.4500
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Subtotal (Total Children Is Unduplicated) 11204 33555 288134.660278 $6766401.3600 $23.4800
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Total 39893 307621.175755 $7609670.9400 $24.7400
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Number of Children (Unduplicated) With at Least One Authorization 12060