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 90090 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 1128 1332 4749.911776 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 7 69.346032 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 281 295 28257.334939 $1045521.4100 $37.0000
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Subtotal (Total Children Is Unduplicated) 1406 1640 33089.903859 $1046013.9200 $31.6100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 390 593 636.491378 $30869.8900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 15 15 20.761872 $1172.8400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 6 2.338891 $46.1000 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 856 913 997.900796 $23440.6900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 22 21.855557 $303.1400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 11 16 14.888889 $352.8700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 23 35 31.712558 $287.9500 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 26 36 35.983335 $1001.4200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 8 8.750001 $336.6200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 15 19 18.707003 $1587.1200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 4 2.523668 $128.8900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 19 27 23.372224 $390.3200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 18 15.468113 $346.4900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 18 26 86.710644 $3901.9900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 15 17.707305 $2036.3300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 101 126 113.831275 $5691.5800 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 2235 2315 3974.743493 $198737.1600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 21 21 24.008218 $1800.6200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 53 55 46.488205 $3486.6200 $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 12 12 8.019179 $601.4400 $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 16 16 16.030530 $1202.2900 $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 22 28 23.210962 $1740.7900 $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 144 152 132.557060 $7356.8500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 23 23 14.616438 $811.2000 $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 335 338 296.653449 $22248.9200 $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 41.049346 $3078.5700 $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 595 598 679.527218 $37713.6800 $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 249 272 405.869877 $30440.1400 $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 6 7 72.971427 $3648.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 25.219047 $1260.9500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 22 27 13.616668 $695.1400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 6 6 6.022222 $307.4300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 31 36 51.106199 $2608.9800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 207 237 236.211526 $12058.6100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 23 31 25.250001 $1289.0200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.216666 $113.1600 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 14 15 11.991780 $612.1800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 131 174 154.063047 $7864.9300 $51.0500
SCREEN-T1023 SCREENING 32 33 53.054762 $2652.7400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 3 2.515525 $37.7300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 3.850000 $196.5400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 10 11 10.038889 $512.4900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 242 288 271.676304 $13869.0800 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 3.000000 $153.1500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 7 7 5.518037 $281.7000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 53 55 78.822647 $3511.5500 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.816666 $90.8300 $50.0000
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Subtotal (Total Children Is Unduplicated) 5108 7040 9032.181707 $453860.8000 $50.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 154 200 238.328005 $1191641.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 8 11.458142 $572.9000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 38 49 82.361492 $4118.0800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 6 4.855555 $347.7000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 38 40 53.488888 $12302.4200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3286 4569 5513.626752 $275682.2300 $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 674 770 617.671453 $15441.8800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5478 8229 30636.661863 $1531832.8100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 73 87 131.492063 $6574.6000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 689 1013 2819.816860 $70495.4100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3559 5561 16012.805124 $800640.2300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 62 67 77.352375 $3867.5900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 293 622 1684.042851 $42101.0600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1980 2995 9976.661470 $498833.0300 $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 6005 8567 23322.632398 $1166131.2500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 92 99 113.158726 $5657.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 687 947 2465.942056 $61648.5300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 58 84 981.885714 $24547.1500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 43.979365 $2198.9700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4332 6352 103412.891166 $5170644.9600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 238 268 2431.552371 $121577.6400 $50.0000
INTR -T1013 INTERPRETER 648 917 5989.708069 $299485.4000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 12123 25001 307123.137020 $3071231.5200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 419 588 8203.143637 $586032.6900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 9 11 68.259525 $4876.4500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 169 232 2995.125397 $171321.1800 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 3 3 36.571428 $2091.8800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 4 5 40.695239 $2907.2700 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 11.000000 $785.8400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 499 722 9853.801598 $703955.6800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 5 21.766666 $1555.0100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 29 38 636.107143 $36359.8900 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 6.357143 $454.1500 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 14.588889 $1042.2300 $71.4400
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 6.548859 $425.6800 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 3 2.515525 $286.7700 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 7 9 12.087519 $2755.9300 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 9 12 21.736225 $9911.7100 $456.0000
SENS -V5264 EARMOLD 29 36 54.309741 $977.5700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1025 1380 19919.509805 $1423050.0300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 35 39 291.568253 $20829.6300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 10 11 193.285714 $11055.9400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.857143 $132.6700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 7 7 59.857144 $4276.1900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 48 54 899.557144 $12485.8500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 158 192 1314.556741 $48638.6300 $37.0000
TRAV -TRAVS Travel by mile 4002 11264 1652761.671874 $735478.9600 $0.4500
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Subtotal (Total Children Is Unduplicated) 20503 81410 2211957.296817 $18182052.4800 $8.2200
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Total 90090 2254079.382383 $19681927.2000 $8.7300
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Number of Children (Unduplicated) With at Least One Authorization 22509