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 22015 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 351 358 607.333602 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 9.714286 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 124 124 3082.203178 $114041.5300 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 474 484 3699.417733 $114047.6900 $30.8300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 137 153 126.504436 $6135.4600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 8.000000 $451.9200 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.038889 $0.7700 $19.7200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 286 286 291.142064 $6838.9300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 4.316667 $59.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.427778 $10.1400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 8 8 4.341477 $39.4200 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 9 9 6.594445 $183.5300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 0.427778 $16.4600 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.102588 $93.5400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.013699 $0.7000 $51.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 1.527778 $25.5100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 2.597033 $58.1800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 7 1.690075 $76.0500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 2.135464 $245.5900 $115.0100
EVAL -96111 DEVELOPMENTAL EVALUATION 17 17 10.576334 $528.8300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 471 475 769.525356 $38476.2600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 6.123288 $459.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 7.005479 $525.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 3.008296 $225.6200 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 0.005556 $0.4200 $75.5900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 5.837378 $437.8100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 2.009589 $150.7200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 2.093151 $156.9800 $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 24 24 38.515070 $2137.5800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 19 19 9.113698 $505.8000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 13 13 25.000000 $1875.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 34 37 36.586301 $2743.9800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 9.500000 $712.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 10 10 18.504110 $1387.8100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 3.500000 $262.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 16 16 11.542466 $865.6900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 63 64 105.242466 $5840.9600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 34 36 33.093149 $1836.6800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 41 79.505479 $5962.9100 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.000000 $225.0000 $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
OCTF -97168 OT RE-EVAL EST PLAN CARE 7 7 1.733334 $88.4900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.400000 $71.4700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 11 11 4.516439 $230.5700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 71 71 40.989498 $2092.5100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 12 6.466667 $330.1300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.244444 $12.4800 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 0.405480 $20.7000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 40 40 23.161113 $1182.3800 $51.0500
SCREEN-T1023 SCREENING 12 12 12.370634 $618.5300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.208219 $3.1200 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 1.755556 $89.6200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 2.172222 $110.8900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 73 73 32.254569 $1646.6000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 4 4 3.123288 $159.4400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 13 13 12.177778 $542.5200 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1302 1554 1792.175632 $87705.9600 $48.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 33 36 34.165526 $170828.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.088889 $4.4500 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 19 15.330366 $766.5200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.627778 $44.9600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 9.611111 $2210.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 781 981 1078.232906 $53911.7000 $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 411 458 346.919082 $8673.0600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1904 2130 2885.122192 $144256.0700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 26 29 30.538888 $1526.9400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 252 272 301.969447 $7549.2600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1258 1441 1610.733731 $80536.7000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 12 13 9.488888 $474.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 96 154 133.428972 $3335.7400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 688 736 956.642939 $47832.1600 $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 2208 2326 2452.061195 $122603.1100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 21 21 21.755554 $1087.7700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 236 248 247.487304 $6187.2000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 20 21 69.807142 $1745.1800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 6.650000 $332.5000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1565 1668 9919.507106 $495975.4300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 98 104 692.919045 $34645.9700 $50.0000
INTR -T1013 INTERPRETER 121 139 521.689683 $26084.4700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4514 6071 29401.272958 $294012.7600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 151 159 1003.475391 $71688.2800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 23.571430 $1683.9300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 60 62 415.885713 $23788.6800 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 24.285714 $1389.1400 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 3.857143 $275.5500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 186 190 910.641261 $65056.2900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 4.809524 $343.6000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 11 11 68.199999 $3898.3200 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 11.114286 $794.0100 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.208219 $13.5300 $64.9900
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.208219 $23.7300 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 2.958904 $674.6500 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 3.044445 $1388.2900 $456.0100
SENS -V5264 EARMOLD 10 10 4.503350 $81.0600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 328 340 2100.794033 $150080.7900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 15 15 115.647618 $8261.8700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 36.142859 $2067.3700 $57.2000
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 25.428572 $1816.6100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 17 17 142.535713 $1978.4000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 89 103 666.075001 $24644.7800 $37.0000
TRAV -TRAVS Travel by mile 1283 2047 140226.259928 $62400.6900 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 7693 19977 196623.403536 $1930566.9900 $9.8200
-------------------------------------------------------------------------------------------------------------------------------------
Total 22015 202114.996901 $2132320.6400 $10.5500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 8526