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: 07-01-19 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 116063 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 4 4 7.922223 $293.1300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 972 1169 3920.838737 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 9 73.717460 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1930 2495 228739.511965 $8463362.1000 $37.0000
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Subtotal (Total Children Is Unduplicated) 2761 3677 232741.990385 $8463655.2300 $36.3600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 310 454 456.797919 $22154.6900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 31 32 59.149652 $3341.3700 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 21.820352 $430.0800 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1119 1194 1379.465534 $32403.6400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 41 44 47.089803 $653.1400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 86 92 115.767459 $2743.6800 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 32 39 41.857382 $380.0600 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.961111 $9.5700 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 53 62 79.136746 $2202.3700 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 5 8.000000 $307.7600 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 59 67 90.588889 $7685.5600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 26 26 22.719103 $1160.2700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 68 74 70.696652 $1180.6300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 18 22 29.409132 $658.7600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 36 41 33.449316 $1505.2200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 25 35 34.394750 $3955.4100 $115.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 1 1 11.285714 $687.9800 $60.9600
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 16.428571 $801.0600 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 102 122 101.438581 $5071.9400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1675 1730 2954.660258 $147733.0100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 14 16 20.798630 $1559.9000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 141 142 218.730595 $16404.7600 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 12 12 21.011111 $1575.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 48 48 70.525872 $5289.4400 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 31 31 41.202741 $3090.1900 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 10 10 15.015221 $1126.1400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 134 176 234.878393 $17615.8200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 207 226 266.633645 $14798.0800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 16 16 16.035769 $889.9800 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.500000 $83.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1408 1415 2360.177036 $177013.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 183 186 352.043834 $26403.2900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 663 666 1201.301656 $90097.6700 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 26 26 50.005479 $3750.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 385 386 410.160303 $30761.8100 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 95 96 154.075346 $11555.6400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2042 2075 3250.844958 $180421.7200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 98 98 189.513698 $10518.0100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1328 1554 2574.327476 $193074.5400 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 8.000000 $600.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 10 79.438093 $3971.9000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 17 78.261903 $3913.0900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 162 209 104.649173 $5342.3900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 21 22 34.278658 $1749.9200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 155 179 147.301464 $7519.7700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 1084 1371 1193.902786 $60948.7500 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 0.655556 $33.4700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 112 145 132.366372 $6757.3500 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 2 2.005556 $102.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 17 18 15.550000 $793.8300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 82 92 137.178278 $7002.9500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 707 1014 895.196072 $45699.8800 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 2.084932 $106.4300 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.083333 $4.2500 $51.0300
SCREEN-T1023 SCREENING 159 176 211.842852 $10592.1200 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.088889 $16.3300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 35 39 79.034691 $4034.7200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 44 47 41.610122 $2124.2000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1226 1549 1341.436927 $68480.4100 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.544444 $129.8900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 29 30 29.766667 $1519.5900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 188 208 320.418656 $14274.6400 $44.5500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.955556 $34.3800 $35.9800
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 2 2 1.866667 $141.3500 $75.7200
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.872222 $43.6100 $50.0000
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Subtotal (Total Children Is Unduplicated) 8908 16379 21896.288556 $1267583.3000 $57.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 324 463 524.356689 $2621785.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 19 22 37.973135 $1898.6500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 57 81 175.787695 $8789.3900 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.961111 $68.8200 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 19 21 49.235236 $3525.7300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 110 114 146.240195 $33635.2900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2669 3736 4588.286956 $229414.9500 $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 729 888 771.487572 $19287.2600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4284 6544 22774.146740 $1138706.9200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 15 17 22.172221 $1108.6100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 578 848 2400.996424 $60024.9000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2379 3843 10922.923626 $546146.1200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 6 7 7.413492 $370.6800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 218 492 1377.739676 $34443.4800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1578 2339 7106.777406 $355338.8400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 8 8 8.138888 $406.9400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 81 162 589.304763 $14732.6200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4192 6041 15752.408288 $787620.0200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 15 15 19.216666 $960.8300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 561 786 2075.511105 $51887.7600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 16 16 95.657141 $7013.5800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 656 1344 28082.100762 $702052.5700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 57.364286 $2868.2200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15397 24519 372203.210868 $18610162.4800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 180 191 1553.195229 $77659.7700 $50.0000
INTR -T1013 INTERPRETER 613 864 5330.975161 $266548.7800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9209 19453 230674.844624 $2306748.6200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2085 3121 39197.932884 $2800300.7900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 36 38 266.303966 $19024.7600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 870 1349 16729.615051 $956934.0600 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 11 11 113.714285 $6504.4500 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 6 6 39.890476 $2849.7700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2227 3399 42989.681114 $3071183.3700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 18 19 94.882539 $6778.4300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 335 542 6425.025628 $367254.4500 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 2 21.571428 $1233.0200 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 10.819047 $772.9100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 6 6 21.152381 $1511.1300 $71.4400
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.377778 $89.5600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 15 23 15.830136 $3609.2900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 3 3.000000 $684.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 17 21 36.816667 $16788.4200 $456.0000
SENS -V5264 EARMOLD 84 113 200.754339 $3613.5800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3254 4892 63894.808715 $4564645.6200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 58 59 425.633328 $30407.2400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 41 54 547.811906 $31334.8500 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 12.857143 $918.5100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 15 15 82.735714 $5910.6300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 327 496 5490.217450 $76204.2100 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $31.7300 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 64 76 451.274994 $16697.1700 $37.0000
TRAV -TRAVS Travel by mile 3183 8904 1408505.425435 $626784.9200 $0.4500
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Subtotal (Total Children Is Unduplicated) 19758 96007 2292947.884224 $40496126.1800 $17.6600
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Total 116063 2547586.163165 $50227364.7100 $19.7200
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Number of Children (Unduplicated) With at Least One Authorization 21595