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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 32297 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 1 1 1.966667 $72.7700 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 329 339 511.210316 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 119 121 3784.684131 $140033.3200 $37.0000
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Subtotal (Total Children Is Unduplicated) 446 461 4297.861114 $140106.0900 $32.6000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 138 152 115.785442 $5615.5900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 17 17 24.072222 $1359.8400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 4.044444 $79.7200 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 337 339 351.142062 $8248.3300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 19 19 14.150000 $196.2600 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 43 44 24.083334 $570.7800 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 22 22 16.508143 $149.8900 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $9.9600 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 22 22 18.149999 $505.1100 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 5 4.044444 $155.5900 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 28 29 25.235922 $2141.0200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 7 7 5.047032 $257.7500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 25 25 23.316666 $389.3900 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 18 18 24.915873 $558.1100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 23 24 19.780137 $890.1100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 7.170701 $824.6300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 30 34 35.211035 $1760.5600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 3 6.000000 $300.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 431 438 791.034629 $39551.7200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 57 57 118.934127 $8920.0700 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 18 18 31.016590 $2326.2500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 14.500000 $1087.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 14.005479 $1050.4100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 9 9 14.005479 $1050.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 39 52 93.557534 $7016.8200 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 123 129 247.641063 $13744.0800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 18 18 19.596956 $1087.6300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 371 371 705.617806 $52921.3400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 356 358 704.074123 $52805.5700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 182 182 351.987671 $26399.0800 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 114 116 229.005479 $17175.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 42 42 70.008219 $5250.6200 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 150 151 283.057534 $21229.3100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 602 611 1102.848327 $61208.1100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 128 130 243.021917 $13487.7200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 341 378 671.652506 $50373.9800 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 14 14 27.000000 $2025.0000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.571429 $78.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 6 17.171430 $858.5800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 55 58 26.434837 $1349.5100 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 4 4 0.844977 $43.1300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 6 7 5.472223 $279.3600 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.022222 $1.1300 $51.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 53 54 54.454816 $2779.9200 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 3.483333 $177.8200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 382 398 237.503284 $12124.5500 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 1.742541 $88.9500 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.316667 $16.1700 $51.0600
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 32 32 13.422995 $685.2500 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 1.005556 $51.3400 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 2 4.000000 $204.2000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 30 30 19.036378 $971.8100 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.194444 $9.9200 $51.0400
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 0.288889 $14.7500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 269 288 164.954416 $8420.9100 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 0.594444 $30.3400 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 0.750000 $38.2900 $51.0500
SCREEN-T1023 SCREENING 95 100 99.411111 $4970.5600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.358904 $5.3800 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 11.052055 $564.2100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 22 22 27.144444 $1385.7200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 492 509 287.907129 $14697.6400 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 18 18 9.831428 $501.8800 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.438889 $73.4600 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 13 14 9.473038 $483.5900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 52 53 47.711111 $2435.6500 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.005556 $0.2900 $51.4600
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.327778 $16.7300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 82 82 83.108165 $3702.4700 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.100000 $4.4600 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.300000 $15.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3567 5606 7609.657384 $461550.5800 $60.6500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 150 170 175.591128 $877955.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 10 15.033334 $751.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 34 34 37.761645 $1888.0900 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 3 6.285714 $450.1200 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 10 10 10.711111 $767.0200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 30 31 27.428844 $6308.6500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 916 1155 1126.833408 $56341.7600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 63 73 48.180655 $2409.0500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 322 413 328.268608 $8206.7800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1487 1627 2592.253926 $129612.7200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 51 54 46.914288 $2345.7300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 165 174 172.941268 $4323.5300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1070 1204 1516.257928 $75812.8800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 57 57 59.888888 $2994.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 74 107 120.071435 $3001.8100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 625 664 798.596839 $39929.9000 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 48 48 52.027779 $2601.4000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 29 48 53.670833 $1341.7700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1777 1847 2148.799411 $107439.9400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 76 78 93.667459 $4683.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 159 167 154.947618 $3873.6900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 157 168 1625.500005 $40637.4900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 2.272222 $113.6100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 1.142857 $57.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5739 6134 37766.175908 $1888308.6000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 406 422 2132.579298 $106629.0000 $50.0000
INTR -T1013 INTERPRETER 198 234 577.362492 $28868.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3305 4556 22810.568304 $228105.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 949 1017 5557.902978 $397056.5800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 53 54 228.315075 $16310.8200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 255 266 1519.714290 $86927.6300 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 10 10 50.900001 $2911.4700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 9 10 35.495238 $2535.7800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 36 37 150.202381 $10730.4500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1024 1070 5448.081503 $389211.0500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 45 49 213.017461 $15217.9600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 59 64 442.730952 $25306.4900 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 7 7 22.364286 $1278.3400 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 7 7 39.895238 $2850.1300 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 35 37 167.072223 $11935.6300 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 1.410959 $91.7200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.235617 $26.8700 $114.0400
SENS -V5050 IN EAR MONAURAL HEARING AID 7 7 5.414156 $1234.4100 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 3 3.000000 $684.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 6 2.611111 $1190.6600 $456.0000
SENS -V5264 EARMOLD 38 38 44.008067 $792.1400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1876 2004 11718.938061 $837200.9900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 111 115 541.757934 $38703.1800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 9 44.071429 $2520.8800 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 2 12.000000 $686.4000 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 23 23 167.223810 $11946.4700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 54 55 302.253970 $21593.0300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 79 84 573.004760 $7953.3100 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 12.714286 $176.4700 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 19 20 38.609525 $1428.5600 $37.0000
TRAV -TRAVS Travel by mile 1061 1735 95750.421680 $42608.9400 $0.4500
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Subtotal (Total Children Is Unduplicated) 9030 26230 197595.100196 $5556869.3000 $28.1200
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Total 32297 209502.618694 $6158525.9700 $29.4000
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Number of Children (Unduplicated) With at Least One Authorization 10662