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: 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 31314 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 2 2 5.377778 $198.9800 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 286 296 513.126202 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 5.857143 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 295 298 2469.185716 $91359.8800 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 582 597 2993.546839 $91558.8600 $30.5900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 141 155 149.850555 $7267.7500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 21 21 31.266667 $1766.2600 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 3.466667 $68.3300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 283 283 300.201588 $7051.7400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 15 15 12.911112 $179.0800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 38 38 21.888888 $518.7600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 19 19 20.235617 $183.7400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 18 18 17.481736 $486.5200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 2.466667 $94.8900 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 26 26 24.113394 $2045.7800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 5 5 4.235616 $216.3100 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 18 18 17.466667 $291.6900 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 18 18 21.002284 $470.4500 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 24 24 18.718284 $842.3200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 6.242007 $717.8300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 17 18 14.289498 $714.4800 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 441 446 760.042031 $38002.1000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 12 12 18.123288 $1359.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 18 18 31.544291 $2365.8200 $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 4 4 8.500000 $637.5000 $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 10.837378 $812.8100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 12 12 16.024810 $1201.8600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 18 21 22.468495 $1685.1200 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 1.010959 $75.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 69 70 117.359361 $6513.4400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 30 30 29.624809 $1644.1700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 97 97 182.502740 $13687.7000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 266 273 481.639724 $36122.9900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 44 45 79.026026 $5926.9500 $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 16 16 28.502740 $2137.7000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 134 137 211.620552 $15871.5300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 352 355 621.548096 $34495.9200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 143 145 239.620546 $13298.9500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 319 415 757.004064 $56775.3300 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 7.000000 $525.0000 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 5 13.223810 $661.1900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 62 66 27.942108 $1426.4500 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.150685 $7.6900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 3.172222 $161.9400 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 34 34 30.927486 $1578.8400 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
OCTH -97167 OT EVAL HIGH COMPLEXITY 348 370 211.753825 $10810.0300 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 0.706925 $36.0800 $51.0400
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 1.194444 $60.9700 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 1.138889 $58.1400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 33 35 90.647415 $4627.5700 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 2 2.005556 $102.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 24 25 19.432649 $992.0400 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.372222 $19.0000 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 237 245 152.601771 $7790.3000 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 5 5 2.557154 $130.5400 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 3 0.475037 $24.2500 $51.0500
SCREEN-T1023 SCREENING 102 102 98.777779 $4938.9000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.389041 $20.8400 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 9 9 9.150685 $467.1400 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 17 19 16.772223 $856.2300 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 420 441 248.398555 $12680.7400 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 14 14 8.923440 $455.5400 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 5.261111 $268.5800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 12 12 12.000000 $612.6000 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.505556 $25.8100 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.188889 $9.6400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 119 122 114.238728 $5089.3400 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.944444 $47.2200 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2902 4405 5492.596580 $319171.4300 $58.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 130 143 125.662841 $628314.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 9 11.688889 $584.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 26 27 20.166898 $1008.3600 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 7 7 7.616667 $545.4300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 28 30 42.563546 $9789.6100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 794 997 1111.838482 $55591.9600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 56 63 53.855514 $2692.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 586 709 603.631481 $15090.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1525 1684 2825.705556 $141285.3100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 53 58 65.112699 $3255.6400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 181 191 199.221428 $4980.5300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1090 1219 1578.496057 $78924.9400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 60 64 70.311106 $3515.5300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 71 104 128.622228 $3215.5700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 608 662 758.984985 $37949.1900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 37 39 39.177777 $1958.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 34 59 49.348415 $1233.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1788 1860 2194.626685 $109731.4400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 77 81 82.136506 $4106.8200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 168 170 154.916666 $3872.9200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 185 254 1612.214302 $40305.2700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 17.636508 $881.8300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 12.000000 $600.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5506 5848 37291.902374 $1864595.0200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 453 484 3007.320633 $150366.0600 $50.0000
INTR -T1013 INTERPRETER 111 128 439.811906 $21990.5900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3301 4556 23533.568231 $235335.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 914 981 5178.424037 $369946.6300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 65 70 354.249205 $25307.5600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 316 343 1895.659518 $108431.7500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 9 9 35.178573 $2012.2100 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 13 14 125.552383 $8969.4600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 34 35 214.599998 $15331.0200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 987 1045 5662.730447 $404545.3900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 54 58 292.702382 $20910.6700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 72 82 433.138095 $24758.2000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 6 6 27.400000 $1566.1800 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 11 12 56.195236 $4014.5900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 31 36 166.807141 $11916.7100 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 1.093151 $71.0600 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.265754 $30.3000 $114.0200
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 6.472146 $1475.6600 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 7 14.243379 $6494.9900 $456.0000
SENS -V5264 EARMOLD 33 33 33.661494 $605.9100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1808 1921 11169.068492 $797918.3200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 168 175 1020.560314 $72908.8400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 18 23 89.714286 $5131.6600 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.285714 $359.5400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 13 13 63.285715 $4521.1300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 61 63 340.610318 $24333.2100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 121 137 704.927520 $9784.4100 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.857143 $25.7800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 69 79 387.806743 $14348.8700 $37.0000
TRAV -TRAVS Travel by mile 1080 1701 93440.384110 $41580.9700 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 8745 26312 197764.011674 $5399551.4800 $27.3000
-------------------------------------------------------------------------------------------------------------------------------------
Total 31314 206250.155093 $5810281.7600 $28.1700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 9786