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
Eligibility Filter: Program Patients
With the filters selected there were 158034 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 1179 1391 4963.455412 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 8 82.488889 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2069 2245 241237.692940 $8925794.7700 $37.0000
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Subtotal (Total Children Is Unduplicated) 3102 3650 246296.948353 $8926287.2800 $36.2400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 447 682 714.218622 $34639.6500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 89 97 135.303957 $7643.3200 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 9 13 10.338891 $203.7800 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1422 1524 1773.333943 $41655.6200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 56 75 90.278313 $1252.1600 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 135 154 146.688889 $3476.5300 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 73 98 131.915614 $1197.8000 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 2.016667 $20.0900 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 99 123 185.224747 $5154.8100 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 8 14 14.750001 $567.4400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 92 111 131.929225 $11192.8900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 24 27 28.484170 $1454.6900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 96 112 109.190261 $1823.4800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 42 58 81.007536 $1814.5700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 79 103 165.318254 $7439.3300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 51 71 80.029756 $9203.4300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 112 140 131.341398 $6567.0900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 2309 2393 4112.238731 $205611.9300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 34 36 45.716437 $3428.7300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 203 205 284.595361 $21344.6200 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 17 17 25.019407 $1876.4600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 60 60 84.093758 $6307.0400 $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 46 46 57.057929 $4279.3300 $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 173 235 310.895823 $23317.1000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 1.010959 $75.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 353 384 441.206207 $24486.8000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 39 40 38.638509 $2144.4200 $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 2080 2091 3313.476076 $248510.3600 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 266 273 481.639724 $36122.9900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 908 912 1638.830615 $122912.3400 $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 574 577 527.186359 $39538.6600 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 134 137 211.620552 $15871.5300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2870 2907 4398.344389 $244107.8500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 146 148 243.626025 $13521.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1837 2144 3509.452407 $263208.8300 $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 11 13 135.971427 $6798.5600 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 20 33 232.586509 $11629.3200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 222 295 212.494739 $10847.9200 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.150685 $7.6900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 31 33 46.932540 $2395.9000 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 232 263 262.662012 $13408.9400 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
OCTH -97167 OT EVAL HIGH COMPLEXITY 1568 1999 1806.645798 $92229.3100 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 0.706925 $36.0800 $51.0400
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 1.194444 $60.9700 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 3 3 1.655556 $84.5200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 141 190 175.113256 $8939.6000 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 3 4.005556 $204.4900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 14 17 17.255555 $880.8900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 117 129 169.130486 $8634.1100 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.372222 $19.0000 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 952 1348 1241.589811 $63383.2100 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 6 6 3.557154 $181.5900 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 3 0.475037 $24.2500 $51.0500
SCREEN-T1023 SCREENING 287 311 364.991266 $18249.5400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 8 14 68.103153 $1021.5500 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 53 58 82.759925 $4224.8900 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 80 87 97.988740 $5002.3300 $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 1879 2421 2133.115940 $108895.7500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 21 21 15.628159 $797.8200 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.972222 $100.6800 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 5.261111 $268.5800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 50 55 53.470015 $2729.6400 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 2 0.533334 $27.2300 $51.0600
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.188889 $9.6400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 348 387 513.557845 $22879.0100 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $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) 12401 23807 31441.143629 $1805621.8100 $57.4300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 499 709 810.892559 $4054467.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 31 46 110.585924 $5529.3100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 103 149 350.454570 $17522.7500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 15.777778 $1129.8500 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 28 33 120.658730 $8640.3700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 134 159 267.826134 $61599.9800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3745 5207 6343.735041 $317187.6600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 58 65 57.788847 $2889.4500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1090 1334 1148.128916 $28703.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5557 8345 30848.649869 $1542432.2000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 73 87 131.492063 $6574.6000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 694 1019 2832.055748 $70801.3800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3596 5613 16104.860591 $805243.0000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 62 67 77.352375 $3867.5900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 293 623 1685.192851 $42129.8100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2042 3075 10094.191633 $504709.5700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 47 51 61.399998 $3069.9900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 90 208 664.119842 $16603.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6072 8656 23498.742718 $1174936.7800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 92 99 113.158726 $5657.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 696 957 2476.792055 $61919.7800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 738 1505 29317.623818 $732940.5200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 43.979365 $2198.9700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 12.000000 $600.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 19705 30917 490608.662159 $24530434.5500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 790 871 7677.474588 $383873.7600 $50.0000
INTR -T1013 INTERPRETER 686 984 6236.073148 $311803.6600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 12125 25010 307280.565591 $3072805.8000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3089 4802 62801.012673 $4486504.8400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 131 150 1201.403167 $85828.2300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1173 1814 23462.542042 $1342057.5300 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 33 33 358.464285 $20504.1400 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 14 15 132.623812 $9474.6400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 36 37 227.885712 $16280.1500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3176 5113 68472.112359 $4891648.2700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 117 127 1042.855553 $74501.6300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 345 554 7367.469586 $421124.6000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 11 11 88.695238 $5069.8200 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 11 12 56.195236 $4014.5900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 35 40 208.473808 $14893.3800 $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 9 13 14.467581 $940.4000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 8 6.174886 $703.9400 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 25 36 33.149314 $7557.9900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 10 12 19.866667 $4529.6100 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 34 45 98.308751 $44828.7700 $456.0000
SENS -V5264 EARMOLD 138 197 462.615670 $8327.0800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6004 9128 126454.821662 $9033933.3000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 290 327 2573.798403 $183872.1700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 62 91 986.624604 $56434.9300 $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 20 21 219.428572 $15675.9800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 74 78 482.038889 $34436.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 443 642 7725.571165 $107230.9300 $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 159 194 1322.556741 $48934.6300 $37.0000
TRAV -TRAVS Travel by mile 4003 11271 1655569.814731 $736728.5800 $0.4500
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Subtotal (Total Children Is Unduplicated) 27223 130577 2900405.349601 $59427567.6100 $20.4900
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Total 158034 3178143.441583 $70159476.7000 $22.0800
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Number of Children (Unduplicated) With at Least One Authorization 29158