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 94349 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 1220 1454 4718.552444 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 9 73.717460 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 295 333 29686.470656 $1098399.4400 $37.0000
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Subtotal (Total Children Is Unduplicated) 1510 1800 34486.662783 $1098692.5600 $31.8600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 413 592 579.836129 $28122.0800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 12 13 13.734171 $775.8500 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 6 8 6.416668 $126.4800 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 722 754 834.978572 $19613.6500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 20 21.311111 $295.5900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 20 25 24.455555 $579.6000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 23 31 29.214688 $265.2700 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 26 33 34.438889 $958.4300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 10 12.827778 $493.4900 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 19 21 23.259135 $1973.3300 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 11 12 4.898022 $250.1500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 22 27 27.432541 $458.1200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 12 17 14.636910 $327.8700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 16 19 73.971734 $3328.7300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 11 13 17.502739 $2012.8000 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 2 2 27.000000 $1316.5200 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 111 135 114.558862 $5727.9600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 2274 2364 4036.514826 $201825.7400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 18 18 14.219177 $1066.4400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 51 54 36.971539 $2772.8800 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 3.008296 $225.6200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 13 8.502512 $637.6900 $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 14 14 8.597653 $644.8200 $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 23 28 22.806091 $1710.4200 $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 127 135 100.638719 $5585.3800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 20 20 9.116438 $505.9500 $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 335 338 296.784956 $22258.7800 $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 111 111 174.174165 $13063.0700 $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 158 159 40.115099 $3008.5100 $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 595 598 678.257355 $37643.2000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 35 37 33.098628 $1836.9800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 249 271 405.782206 $30433.5600 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 3.002740 $225.2000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 10 79.438093 $3971.9000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 7 37.785713 $1889.2800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 22 28 16.105557 $822.2000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 6.744444 $344.3000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 39 41 58.887782 $3006.2400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 207 236 240.240237 $12264.2700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 28 37 26.983332 $1377.4900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 4.472222 $228.3100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 13 15 12.250609 $625.4000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 124 170 149.274420 $7620.4600 $51.0500
SCREEN-T1023 SCREENING 36 37 60.484921 $3024.2500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 4 3.431572 $51.4700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 4.551066 $232.3300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 10 11 10.133333 $517.3100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 275 322 356.329347 $18190.6100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 7 7 5.079148 $259.2900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 48 50 66.089314 $2944.2800 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.872222 $43.6100 $50.0000
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Subtotal (Total Children Is Unduplicated) 5094 6968 8949.376217 $453115.7900 $50.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 155 208 245.411493 $1227059.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 12 12.000912 $600.0400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 49 61 98.594171 $4929.7000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.428571 $102.3000 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 4 3.727777 $266.9400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 40 44 49.605098 $11409.1500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3304 4592 5438.029349 $271902.4100 $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 658 752 608.663177 $15216.6800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5888 9037 31706.749517 $1585337.0900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 26 29 36.205554 $1810.2700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 726 1065 2889.101389 $72227.5400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3512 5579 16012.042007 $800601.9500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 12 13 10.274602 $513.7300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 292 636 1700.880942 $42522.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2076 3143 9851.712825 $492585.6300 $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 6161 9003 23899.909467 $1194994.8500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 21 21 25.094443 $1254.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 709 987 2570.446820 $64261.1600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 8 55.050793 $4036.3200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 88 126 1500.816663 $37520.4300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 6.650000 $332.5000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4721 6992 106837.839907 $5341892.8300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 100 106 779.447612 $38972.3900 $50.0000
INTR -T1013 INTERPRETER 679 931 5961.958867 $298097.9500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 12552 26646 316880.153211 $3168801.7800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 478 637 8025.892042 $573369.8800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 28.285715 $2020.7300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 162 218 2710.185712 $155022.6300 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 28.571428 $1634.2800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 3.857143 $275.5500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.857143 $61.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 562 817 10192.387689 $728144.3900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 5.276190 $376.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 27 36 531.454759 $30377.9700 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 12.542857 $896.0600 $71.4400
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 6 6.118418 $397.7000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 4 2.640182 $300.9800 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 7.167123 $1634.0800 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 11 14 15.283409 $6969.2300 $456.0000
SENS -V5264 EARMOLD 31 37 45.200456 $813.6100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1100 1502 20261.427263 $1447476.5800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 15 15 130.861903 $9348.7700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 9 163.247618 $9337.7600 $57.2000
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 28.285715 $2020.7300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 60 65 943.404764 $13094.4500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 91 106 726.203566 $26869.5300 $37.0000
TRAV -TRAVS Travel by mile 4242 11808 1787086.440335 $795253.4800 $0.4500
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Subtotal (Total Children Is Unduplicated) 21403 85581 2358917.596877 $18504062.2800 $7.8400
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Total 94349 2402353.635877 $20055870.6300 $8.3500
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Number of Children (Unduplicated) With at Least One Authorization 23363