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: 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 109856 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 6 6 13.311112 $492.5100 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 881 1052 3827.264725 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 7 69.346032 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1533 1678 178684.961168 $6611343.6400 $37.0000
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Subtotal (Total Children Is Unduplicated) 2293 2743 182594.883037 $6611836.1500 $36.2100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 295 446 484.815649 $23513.5700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 39 43 50.024658 $2825.9000 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 2.000000 $39.4200 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 983 1051 1239.636508 $29119.0600 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 21 24 30.355556 $421.0300 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 74 82 73.494445 $1741.8200 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 25 30 56.169190 $510.0200 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 39 44 99.299326 $2763.5000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 4 6.000000 $230.8200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 55 64 81.605555 $6923.4100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 10 11 9.266058 $473.2200 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 52 55 58.090259 $970.1100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 15 18 32.033334 $717.5500 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 35 40 34.429224 $1549.3200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 20 27 25.664003 $2951.3800 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 89 109 95.424883 $4771.2600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1631 1677 2900.434099 $145021.7000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 15 17 23.713698 $1778.5300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 139 140 217.108373 $16283.0900 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 13 13 22.011111 $1650.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 45 45 67.570317 $5067.7800 $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 30 30 40.202741 $3015.1900 $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 130 173 231.650615 $17373.7400 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 220 239 292.254921 $16220.0700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 21 22 27.035769 $1500.4800 $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 184 187 354.043834 $26553.2900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 664 667 1202.150971 $90161.3600 $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 384 385 408.160303 $30611.8100 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 96 97 156.075346 $11705.6400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2040 2072 3232.191730 $179386.4600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 99 99 191.513698 $10629.0100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1328 1554 2565.435956 $192407.6700 $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 6 7 72.971427 $3648.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 19 122.423810 $6121.1900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 157 206 132.085475 $6743.0200 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.150685 $7.6900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 18 19 32.888096 $1678.9400 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 151 172 164.653378 $8405.5900 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
OCTH -97167 OT EVAL HIGH COMPLEXITY 1056 1345 1239.380815 $63270.4200 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.194444 $9.9200 $51.0400
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 0.655556 $33.4700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 89 122 131.274362 $6701.6000 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 3 4.005556 $204.4900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 9 10 10.022222 $511.6300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 77 85 133.236649 $6801.7200 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.372222 $19.0000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 663 941 866.423371 $44230.9600 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 4 4 2.362710 $120.6200 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 3 0.475037 $24.2500 $51.0500
SCREEN-T1023 SCREENING 186 202 233.892060 $11694.5900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 2.877778 $43.1700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 34 38 64.454902 $3290.4200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 46 49 48.389499 $2470.2800 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1182 1539 1389.711576 $70944.9000 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 14 14 9.844825 $502.5800 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 4.261111 $217.5300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 25 27 26.213089 $1338.1700 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.188889 $9.6400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 214 235 350.380174 $15609.4500 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.955556 $34.3800 $35.9800
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 1 1 0.866667 $65.6300 $75.7200
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.816666 $90.8300 $50.0000
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Subtotal (Total Children Is Unduplicated) 8487 15995 21805.360695 $1267045.0500 $58.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 308 432 508.159857 $2540802.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 16 19 40.658143 $2032.9100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 44 66 135.853200 $6792.6800 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 14.777778 $1058.2400 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 18 19 59.130952 $4234.3600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 57 65 98.616667 $22681.8400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2639 3685 4645.473842 $232274.2300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 32 33 21.323484 $1066.1900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 755 916 779.640214 $19491.0700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3965 5953 21864.725108 $1093235.9800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 43 53 74.108731 $3705.4400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 547 808 2364.462695 $59111.5600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2402 3782 11040.480924 $552024.0500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 38 41 55.135710 $2756.7700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 219 473 1353.388889 $33834.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1488 2228 7254.525787 $362726.2400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 29 32 32.516665 $1625.8300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 70 162 553.297615 $13832.4300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4029 5697 15182.164479 $759107.9300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 61 68 74.486506 $3724.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 541 757 2045.862695 $51146.5600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 577 1193 21247.473019 $531186.7600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 43.979365 $2198.9700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14445 22662 360787.478963 $18039374.9600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 540 589 5175.663483 $258783.1800 $50.0000
INTR -T1013 INTERPRETER 587 851 5325.164049 $266258.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8835 18081 221590.430734 $2215904.4200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1941 2977 39036.992413 $2788802.9600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 81 92 766.900789 $54787.3900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 854 1322 17231.962684 $985668.3500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 19 19 189.421429 $10834.9000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 7 7 72.785716 $5199.8000 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 24 25 135.028571 $9646.4400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2067 3287 43562.084800 $3112075.6800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 60 63 509.357143 $36388.4900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 274 446 5796.733872 $331341.3400 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 9 9 85.009524 $4859.1500 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 9 10 47.695236 $3407.3500 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 23 26 123.884919 $8850.3400 $71.4400
PHY -97110TLHM PT SESSION BY PT ASST 1 1 14.714286 $841.0700 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 3.000000 $195.0000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 8 13 8.672146 $1977.2600 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 5 5 5.000000 $1140.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 8 13 29.394445 $13403.8900 $456.0000
SENS -V5264 EARMOLD 61 84 167.023289 $3006.4200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3206 4760 64839.971839 $4632167.9800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 129 141 1165.820627 $83286.2300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 50 73 781.669050 $44711.4700 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.285714 $359.5400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 13 14 135.928572 $9710.7300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 46 49 277.396031 $19817.1700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 321 489 5676.537040 $78790.3400 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 4.142857 $57.5000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 110 134 840.490073 $31098.1500 $37.0000
TRAV -TRAVS Travel by mile 2978 8377 1278514.456955 $568938.9400 $0.4500
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Subtotal (Total Children Is Unduplicated) 18998 91118 2142398.339574 $39922336.2100 $18.6300
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Total 109856 2346798.583306 $47801217.4100 $20.3700
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Number of Children (Unduplicated) With at Least One Authorization 20365