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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 14037 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 0.166667 $6.1700 $37.0100
SCONLY-SCONLY *SERVICE COORDINATION ONLY 278 285 488.212964 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 9.714286 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 21 21 818.155554 $30271.7500 $37.0000
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Subtotal (Total Children Is Unduplicated) 299 308 1316.249471 $30277.9200 $23.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 92 107 93.895606 $4553.9200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 260 260 265.714286 $6241.6300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
EVAL -96111 DEVELOPMENTAL EVALUATION 15 15 8.187445 $409.3800 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 329 333 522.412114 $26120.6000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 0.013698 $0.7600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 14.505479 $805.0600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 6 10.505479 $787.9100 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 9.571428 $478.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 1.466667 $73.3400 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 1.500000 $76.5800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 18 18 6.747945 $344.4800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.355556 $18.1500 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 4.866666 $248.4400 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.172222 $8.7900 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 22 22 5.208904 $265.9100 $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 3 3 3.000000 $133.6500 $44.5500
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Subtotal (Total Children Is Unduplicated) 757 820 993.123495 $43389.4100 $43.6900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 8.983333 $44916.5000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.088889 $4.4500 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 12 12 11.466667 $573.3400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.350000 $25.0600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 562 693 757.110404 $37855.5700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 29 30 17.040151 $852.0200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 297 323 251.798742 $6295.0200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1370 1533 2029.370626 $101468.4900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 15 17 19.538888 $976.9400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 206 221 262.992463 $6574.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 839 975 1098.462301 $54923.1200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 6 7 6.627778 $331.3900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 73 118 113.151196 $2828.8000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 515 555 694.578577 $34728.9500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 8 8 7.494444 $374.7200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 23 38 29.777777 $744.4400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1482 1549 1522.059525 $76103.0000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 15 15 16.555555 $827.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 186 196 204.215081 $5105.3900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 3.671428 $91.7900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 6.650000 $332.5000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 269 284 1689.207927 $84460.4000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 20 21 165.914284 $8295.7300 $50.0000
INTR -T1013 INTERPRETER 109 127 482.261111 $24113.0500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3248 4379 20818.134088 $208181.3700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 30 31 204.378573 $14600.8000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 4.857143 $346.9900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 17 17 89.642856 $5127.5700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 48 49 181.319838 $12953.5100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.142857 $295.9700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 27.771428 $1587.4200 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.955556 $435.7500 $456.0200
SENS -V5264 EARMOLD 2 2 1.955556 $35.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 61 61 305.424207 $21819.5100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 12.571429 $898.1000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 23.857144 $1364.6300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 42.892856 $595.3500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 62 73 416.289286 $15402.7000 $37.0000
TRAV -TRAVS Travel by mile 964 1539 108260.283738 $48175.8300 $0.4500
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Subtotal (Total Children Is Unduplicated) 5065 12909 139794.843702 $824853.9400 $5.9000
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Total 14037 142104.216668 $898521.2700 $6.3200
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Number of Children (Unduplicated) With at Least One Authorization 5638