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 17710 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 275 284 485.476996 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 5.857143 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 96 97 301.987304 $11173.5400 $37.0000
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Subtotal (Total Children Is Unduplicated) 374 384 798.699221 $11372.5200 $14.2400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 124 136 135.327496 $6563.3900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 5.000000 $282.4500 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.466667 $9.2000 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 181 181 188.201588 $4420.8600 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 2.466667 $34.2100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 2.588889 $61.3600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 2.702283 $24.5400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.466667 $40.8200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.466667 $17.9500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 5.224505 $443.2500 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.235616 $12.0300 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 2.466667 $41.1900 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 3.702283 $82.9300 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 7 9.904587 $445.7100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.655403 $75.3700 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 16 17 14.273060 $713.6600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 426 431 738.042031 $36902.1000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 8 12.123288 $909.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 11.538812 $865.4100 $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 7 7 9.837378 $737.8100 $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 6 6 4.454795 $334.1000 $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 35 35 56.013700 $3108.7500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 19 19 9.613698 $533.5500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 12 12 23.000000 $1725.0000 $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 4 4 8.500000 $637.5000 $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 3 3 4.500000 $337.5000 $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 59 60 98.242466 $5452.4600 $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 32 42 79.593150 $5969.4900 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.000000 $225.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 5 1.238890 $63.2500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 0.208220 $10.6200 $51.0200
OCTH -97167 OT EVAL HIGH COMPLEXITY 38 41 24.689421 $1260.3900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 6 6 2.366668 $120.8300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.095890 $4.9000 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 31 31 26.861741 $1371.2900 $51.0500
SCREEN-T1023 SCREENING 7 7 6.777778 $338.8900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.041096 $0.6200 $15.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 44 46 25.879073 $1321.1300 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $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 15 15 22.177778 $988.0200 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.944444 $47.2200 $50.0000
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Subtotal (Total Children Is Unduplicated) 1077 1286 1662.649788 $84400.9700 $50.7600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 28 29 30.204489 $151022.0000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 2.166667 $108.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 10 10 9.468951 $473.4600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.127778 $9.1500 $71.6200
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 4.388889 $1009.4500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 743 927 1016.450103 $50822.5500 $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 416 465 352.678651 $8817.0400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1504 1658 2803.588889 $140179.4800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 53 58 65.112699 $3255.6400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 179 189 196.749206 $4918.7300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1079 1207 1558.784154 $77939.3500 $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 596 649 750.701651 $37535.0200 $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 1773 1844 2173.606844 $108680.4500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 77 81 82.136506 $4106.8200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 162 164 149.372222 $3734.3100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 6 26.500000 $662.5000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 17.636508 $881.8300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1097 1160 7723.460324 $386172.8900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 142 157 1061.119042 $53055.9800 $50.0000
INTR -T1013 INTERPRETER 107 122 430.089684 $21504.4800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3301 4555 23527.853945 $235278.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 117 126 713.523811 $50974.1000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 4 12.285716 $877.6800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 40 42 277.609525 $15879.2600 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 8.000000 $457.6000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 4 5 40.695239 $2907.2700 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 10.142857 $724.6100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 130 134 761.580959 $54407.3200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 8.000000 $571.5200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 27.000001 $1543.3200 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 6.357143 $454.1500 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 3.446032 $246.1800 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.041096 $2.6700 $65.0100
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.041096 $4.6900 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 0.977778 $445.8800 $456.0100
SENS -V5264 EARMOLD 3 3 2.644445 $47.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 253 265 1615.022225 $115377.1600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 22 22 86.425398 $6174.2200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 23.142858 $1323.7700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.857143 $132.6700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 47.285715 $3378.0900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 72.500000 $1006.3000 $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
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Subtotal (Total Children Is Unduplicated) 5997 16040 139872.282132 $1616106.3400 $11.5500
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Total 17710 142333.631141 $1711879.8300 $12.0300
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Number of Children (Unduplicated) With at Least One Authorization 6753