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
Eligibility Filter: Program Patients
With the filters selected there were 165482 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 1271 1514 4921.874654 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 9 10 86.860317 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2524 3237 295507.388981 $10933773.6200 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3623 4765 300524.046175 $10934066.7500 $36.3800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 474 692 671.095413 $32548.1500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 65 68 110.308556 $6231.3300 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 20 22 41.237020 $812.7900 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1625 1727 2031.233603 $47713.6800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 84 98 120.065907 $1665.3200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 161 178 214.495236 $5083.5300 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 81 103 116.403729 $1056.9500 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 1.977778 $19.7000 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 118 141 171.296259 $4767.1700 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 13 18 21.827778 $839.7200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 101 118 154.263701 $13087.7500 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 43 48 40.639346 $2075.4500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 111 125 119.551416 $1996.5100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 41 55 71.266590 $1596.3700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 83 99 151.310547 $6808.9800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 57 79 112.026744 $12883.0600 $115.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 1 1 11.285714 $687.9800 $60.9600
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 2 2 27.000000 $1316.5200 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 127 154 135.724541 $6786.2500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 2347 2441 4170.010064 $208500.5100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 30 32 33.012328 $2475.9200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 204 207 278.700917 $20902.5400 $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 64 65 88.499313 $6637.4500 $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 45 45 50.625052 $3796.8600 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 14 14 19.024810 $1426.8600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 177 239 312.640953 $23447.9900 $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 328 359 391.519178 $21729.1700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 33 33 25.138509 $1395.1700 $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 2081 2092 3315.607583 $248670.2300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 265 272 479.639724 $35972.9900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 908 912 1639.981300 $122998.6400 $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 575 578 528.252112 $39618.5900 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 133 136 209.620552 $15721.5300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2871 2908 4398.439300 $244113.1200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 145 147 241.626025 $13410.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1836 2142 3518.253516 $263868.9200 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 7 7 11.002740 $825.2000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 13 15 122.866664 $6143.3200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 21 33 177.110317 $8855.5100 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 223 299 184.771398 $9432.6500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 41 43 52.738855 $2692.3200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 250 279 264.823372 $13519.2900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 1599 2002 1727.604951 $88194.2300 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.272222 $13.9000 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 0.655556 $33.4700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 176 234 181.505262 $9265.9000 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 2 2.005556 $102.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 22 26 24.038889 $1227.1900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 113 128 165.644869 $8456.1700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1017 1437 1277.009192 $65191.4300 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 4 4 2.279376 $116.3600 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.083333 $4.2500 $51.0300
SCREEN-T1023 SCREENING 243 268 334.716661 $16735.8100 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 7 12 42.758557 $641.3800 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 57 61 96.190096 $4910.5100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 79 85 91.687520 $4680.6500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1987 2488 2183.663034 $111476.1200 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 2.733333 $139.5400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 57 60 57.784704 $2949.9100 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.027778 $1.4200 $51.0900
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 296 326 425.663177 $18963.2800 $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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 13011 24244 31577.978482 $1806280.6700 $57.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 537 760 863.204635 $4316026.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 37 50 108.862027 $5443.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 124 171 389.386250 $19469.3200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 2.389682 $171.1300 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 31 35 104.601902 $7490.5300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 184 203 282.654916 $65010.7000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3773 5250 6260.687464 $313035.3200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 53 59 46.672181 $2333.6200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1042 1277 1092.861235 $27321.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5966 9154 31885.424900 $1594270.8500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 26 29 36.205554 $1810.2700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 729 1068 2893.101389 $72327.5400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3575 5657 16148.933929 $807446.5600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 12 13 10.274602 $513.7300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 292 637 1702.030942 $42550.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2141 3233 9972.063621 $498603.1900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 11 11 10.633332 $531.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 103 212 720.904767 $18022.6300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6250 9112 24082.547334 $1204126.7500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 21 21 25.094443 $1254.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 715 994 2576.907931 $64422.6900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 19 19 104.546030 $7665.3100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 840 1683 37765.624567 $944140.6900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 57.364286 $2868.2200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 20953 33343 504754.123730 $25237709.1400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 279 298 2301.903162 $115095.1700 $50.0000
INTR -T1013 INTERPRETER 719 1004 6337.625534 $316881.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 12554 26659 317078.724639 $3170787.5000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3298 5021 63228.309186 $4517031.1700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 59 62 453.161106 $32373.8400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1172 1823 22329.253144 $1277233.3700 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 19 19 204.999998 $11725.9800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 6.857143 $489.8700 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 11 11 64.247618 $4589.8400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3385 5293 67710.598339 $4837246.0700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 40 41 258.439680 $18462.9500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 418 665 8059.197056 $460663.6900 $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 9 10 40.161905 $2869.1800 $71.4400
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 11 9.934856 $645.7700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 6 3.841552 $437.9400 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 29 42 31.921155 $7277.9900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 10 11 16.400000 $3739.2000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 39 52 80.578463 $36743.8000 $456.0000
SENS -V5264 EARMOLD 162 222 438.107003 $7885.9300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6118 9378 125170.393445 $8942173.9100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 130 135 981.304754 $70104.4200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 51 66 669.586508 $38300.3600 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 4 4 63.428571 $4531.3400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 26 26 151.950000 $10855.2900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 474 682 7784.134907 $108043.7800 $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 93 108 734.203566 $27165.5300 $37.0000
TRAV -TRAVS Travel by mile 4243 11818 1788723.297478 $795981.8800 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 28187 136473 3054865.338606 $60075940.7300 $19.6700
-------------------------------------------------------------------------------------------------------------------------------------
Total 165482 3386967.363263 $72816288.1400 $21.5000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 30796