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 23074 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 290 293 460.892855 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 27 27 1835.015874 $67895.5900 $37.0000
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Subtotal (Total Children Is Unduplicated) 316 321 2296.742062 $67926.4200 $29.5800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 135 154 148.361951 $7195.5600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 6.095890 $344.3600 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.083333 $1.6400 $19.7000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 241 241 252.940476 $5941.5700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 5.638889 $78.2100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 8 8 5.788889 $52.5600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 8 8 6.488889 $180.5900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.088889 $92.3800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 3.233333 $54.0000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 2.000000 $44.8000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 0.242314 $10.9100 $45.0200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 0.518949 $59.6700 $114.9900
EVAL -96111 DEVELOPMENTAL EVALUATION 24 28 28.171462 $1408.5900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 594 603 965.638206 $48281.9200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 6.460274 $484.5200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 17 18 14.045204 $1053.3900 $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 4 4 4.179452 $313.4600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 10 14 12.263015 $919.7100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 48 49 20.517811 $1138.7200 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 2.002740 $111.1500 $55.5000
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 146 146 151.152834 $8388.9800 $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
OCTF -97168 OT RE-EVAL EST PLAN CARE 6 6 8.183334 $417.7600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 4.410654 $225.1700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 63 65 71.089834 $3629.1300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 5 4.094444 $209.0200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 3.127778 $159.6700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 38 44 25.620928 $1307.9500 $51.0500
SCREEN-T1023 SCREENING 10 10 9.933333 $496.6700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.232877 $3.4900 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 3.661263 $186.9000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.505556 $25.8100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 65 73 55.178102 $2816.8400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 4 4 4.000000 $204.2000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 20 20 24.132540 $1075.1000 $44.5500
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Subtotal (Total Children Is Unduplicated) 1455 1779 2086.297933 $104383.0900 $50.0300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 48 52 60.683030 $303415.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.455556 $22.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 10 10 10.255555 $512.7800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.455556 $104.2400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 12 12 10.877778 $2501.8900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1083 1264 1167.852924 $58392.9500 $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 153 169 147.739448 $3693.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1751 1919 2931.802296 $146590.1400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 17 17 7.512698 $375.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 248 268 286.411316 $7160.2900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1220 1397 1607.820251 $80390.9700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.919047 $45.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 101 169 168.013894 $4200.3600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 706 767 1103.725679 $55186.2600 $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 2033 2162 2412.097595 $120604.7500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 12 12 2.822222 $141.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 242 256 269.328577 $6733.2200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 16 17 108.960318 $2724.0100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 7.276190 $363.8100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1549 1672 11385.897629 $569294.9200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 101 102 226.988892 $11349.4500 $50.0000
INTR -T1013 INTERPRETER 221 266 889.066717 $44453.3500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4806 6533 33686.730069 $336867.2800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 141 148 913.607939 $65268.1100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 6 6 8.771429 $626.6400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 72 78 424.571430 $24285.5000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 4.285714 $245.1400 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.857143 $61.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 166 185 978.885319 $69931.5700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 3 1.666667 $119.0700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 13 13 86.464287 $4942.2900 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 5.428571 $387.8200 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.232877 $80.1400 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.232877 $26.5500 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 4.291552 $978.4600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 1.233334 $562.4300 $456.0200
SENS -V5264 EARMOLD 11 11 6.780441 $122.0500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 347 365 2322.886853 $165947.1100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 16 16 22.642856 $1617.6100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 23.714285 $1356.4600 $57.2000
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.142857 $81.6500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 16 17 150.500003 $2088.9400 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 91 109 97.519048 $3608.2400 $37.0000
TRAV -TRAVS Travel by mile 1559 2873 152079.728677 $67675.4800 $0.4500
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Subtotal (Total Children Is Unduplicated) 8108 20974 213675.381842 $2166336.2300 $10.1400
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Total 23074 218058.421837 $2338645.7500 $10.7200
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Number of Children (Unduplicated) With at Least One Authorization 8839