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
Eligibility Filter: Program Patients
With the filters selected there were 38917 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 366 374 640.919317 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 9.714286 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 777 781 21622.304787 $800025.3200 $37.0000
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Subtotal (Total Children Is Unduplicated) 1117 1157 22273.105057 $800031.4900 $35.9200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 159 179 146.073538 $7084.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 23 23 36.127778 $2040.8600 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.038889 $0.7700 $19.7200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 440 440 478.020635 $11228.7100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 17 17 12.872222 $178.5400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 35 36 25.761111 $610.5400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 25 25 19.077854 $173.2300 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 30 32 24.622908 $685.2600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 0.427778 $16.4600 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 26 26 23.669253 $2008.0900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 6 6 4.052588 $206.9700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 23 23 17.918341 $299.2400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 12 12 6.424810 $143.9200 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 26 26 12.312906 $554.0700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 16 16 7.945586 $913.7600 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 20 20 13.592772 $679.6500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 495 500 810.169800 $40508.4800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 7 9.123288 $684.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 21 21 33.010958 $2475.8300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 16 16 24.019407 $1801.4600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 10.500000 $787.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 2.005556 $150.4200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 11.837378 $887.8100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 14 14 19.024810 $1426.8600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 16 19 21.106851 $1583.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 0.010959 $0.8300 $75.2800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 55 57 90.059362 $4998.2900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 28 28 25.124809 $1394.4200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 100 100 188.002740 $14100.2000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 265 272 479.639724 $35972.9900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 46 47 82.026026 $6151.9500 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 44 44 84.509589 $6338.2200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 15 15 27.502740 $2062.7000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 133 136 209.620552 $15721.5300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 358 361 634.501324 $35214.8300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 142 144 237.620546 $13187.9500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 320 416 762.939876 $57220.5200 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 7.000000 $525.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 9.571428 $478.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 9 13.246032 $662.3000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 65 68 21.358250 $1090.3300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 4.694444 $239.6500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 59 59 37.200611 $1899.1000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 506 527 272.767008 $13924.7800 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.272222 $13.9000 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 0.538889 $27.5100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 44 46 91.046350 $4647.9300 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 2 2.005556 $102.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 5 6 4.305555 $219.8000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 30 30 23.380355 $1193.5600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 314 324 178.218651 $9098.0700 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 4 4 2.279376 $116.3600 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.083333 $4.2500 $51.0300
SCREEN-T1023 SCREENING 68 70 63.515078 $3175.7500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 3.541552 $53.1200 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 19 19 20.497043 $1046.3800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 23 25 18.814915 $960.5000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 621 645 344.262238 $17574.6300 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 2.733333 $139.5400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 21 21 19.567733 $998.9400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 113 117 105.938225 $4719.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 3479 5100 5847.133441 $332857.5300 $56.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 162 181 151.902370 $759511.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 10 7.511111 $375.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 43 43 44.378843 $2218.9400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 9 10.894445 $780.1600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 42 42 44.785084 $10300.5700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 843 1061 1185.454618 $59272.7800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 52 58 46.172181 $2308.6200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 558 673 548.520324 $13713.0900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1920 2150 2901.777748 $145088.8500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 26 29 30.538888 $1526.9400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 253 273 303.969447 $7599.2600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1268 1454 1627.078968 $81353.9600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 12 13 9.488888 $474.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 96 155 133.878972 $3346.9900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 707 755 972.720716 $48636.0500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 11 11 9.822221 $491.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 25 41 31.711110 $792.7800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2222 2342 2469.327863 $123466.4500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 21 21 21.755554 $1087.7700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 241 254 252.831748 $6320.8100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 295 381 3116.976961 $77924.5000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 6.650000 $332.5000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7379 7953 47282.466130 $2364123.5400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 268 287 1994.004761 $99700.2800 $50.0000
INTR -T1013 INTERPRETER 128 148 552.475397 $27623.7600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4514 6073 29416.558672 $294165.6100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1202 1298 6975.484400 $498328.6900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 57 59 338.613490 $24190.5600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 420 465 2436.903962 $139390.9900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 19 19 167.285715 $9568.7400 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 6.857143 $489.8700 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 10 10 58.104761 $4151.0000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1232 1296 6422.785699 $458844.0300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 37 38 223.271427 $15950.5400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 120 132 684.285032 $39113.7200 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 2 20.857143 $1192.1900 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 10.819047 $772.9100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 9 10 38.333334 $2738.5500 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 0.405479 $26.3600 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.208219 $23.7300 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 8 8 4.489649 $1023.6500 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 3 2.411111 $549.7300 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 11 11 16.077778 $7331.4800 $456.0000
SENS -V5264 EARMOLD 49 49 43.228235 $778.1100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2169 2331 13325.762134 $951992.6900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 123 126 823.469044 $58828.6500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 25 33 138.785718 $7938.5400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 21.142857 $1510.4500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 25 25 132.807143 $9487.7400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 143 159 797.892856 $11074.7600 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.928571 $26.7700 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 90 104 673.360715 $24914.3500 $37.0000
TRAV -TRAVS Travel by mile 1283 2050 140244.117071 $62408.6300 $0.4500
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Subtotal (Total Children Is Unduplicated) 10695 32660 266783.340753 $6465184.2000 $24.2300
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Total 38917 294903.579251 $7598073.2200 $25.7600
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Number of Children (Unduplicated) With at Least One Authorization 12021