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 60977 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 943 1134 3819.093513 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 9 73.717460 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 65 76 6425.734927 $237752.2000 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1015 1223 10326.468123 $238045.3200 $23.0500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 292 422 430.825772 $20895.0400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.027778 $171.0400 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 621 643 686.466666 $16125.1000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.072222 $25.4100 $23.7000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 3 6.000000 $230.8200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 3.166667 $268.6600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 0.705556 $36.0400 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.044444 $0.9900 $22.3800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.022222 $46.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.511111 $288.7800 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 16.428571 $801.0600 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 95 114 93.838809 $4691.9500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1641 1695 2892.660258 $144633.0100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 6 6.012328 $450.9300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 2.006849 $150.5200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.175342 $163.1500 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 9 6.914536 $518.5800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 23 25 14.949077 $829.6600 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 0.013698 $0.7600 $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 59 59 93.041098 $6978.0700 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 30 30 52.021916 $3901.6500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 19 19 16.039727 $1202.9600 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 111 113 171.679450 $9528.2100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 49 53 96.079452 $7205.9600 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 10 79.438093 $3971.9000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 6 33.285713 $1664.2800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 4 0.966666 $49.3400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 10 10 8.511112 $434.5000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 63 72 81.518798 $4161.5400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 6 2.388889 $121.9500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 7.000000 $357.3500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 31 40 29.960428 $1529.4900 $51.0500
SCREEN-T1023 SCREENING 5 5 5.000000 $250.0000 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 2 3 3.038889 $155.1400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 77 85 79.759439 $4071.7200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 13 13 32.049207 $1427.7900 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.872222 $43.6100 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2941 3500 4997.998484 $239534.5100 $47.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 51 71 105.966668 $529834.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 10 9.289801 $464.4800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 31 39 67.241660 $3362.0800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 2.022222 $144.8100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 15 15 15.577777 $3582.8700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2377 3334 4069.205372 $203460.8600 $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 471 527 446.141788 $11153.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4234 6468 22660.528629 $1133026.0200 $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 2349 3808 10860.640434 $543031.9500 $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 1538 2282 7026.756769 $351337.8000 $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 4149 5990 15676.094002 $783804.3000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 15 15 19.216666 $960.8300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 556 780 2071.049994 $51776.2400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 46.161904 $3384.5900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 25 28 352.435713 $8810.8900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 6.650000 $332.5000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 877 1199 17083.721404 $854186.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 20 21 180.309521 $9015.4800 $50.0000
INTR -T1013 INTERPRETER 590 816 5065.308494 $253265.4500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9208 19447 230583.987482 $2305840.0500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 115 139 1615.857136 $115436.8500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 8.857143 $632.7600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 54 68 842.923014 $48215.2000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 198 262 2695.156352 $192542.0400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.142857 $295.9700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 9 13 195.949999 $11200.5100 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.377778 $24.5600 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 4 3.655555 $1666.9100 $455.9900
SENS -V5264 EARMOLD 14 15 14.855555 $267.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 245 322 3729.370605 $266426.2500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.285714 $949.1300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 4 99.571429 $5695.4800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 19 21 290.557143 $4032.9300 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 63 75 450.989280 $16686.6000 $37.0000
TRAV -TRAVS Travel by mile 3182 8899 1406917.425435 $626078.2600 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 14303 56254 1737656.086910 $8453093.0300 $4.8600
-------------------------------------------------------------------------------------------------------------------------------------
Total 60977 1752980.553517 $8930672.8500 $5.0900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 15669