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: 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 16421 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 279 281 815.511106 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 9 9 23.205951 $858.6200 $37.0000
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Subtotal (Total Children Is Unduplicated) 289 291 840.683724 $931.3900 $1.1100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 128 138 124.895708 $6057.4500 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.288889 $5.6900 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 95 95 102.431746 $2406.1200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 7 5.877777 $81.5200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 7 5.083333 $120.4700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 7 3.888355 $35.3100 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 7 3.649999 $101.5800 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 3.288889 $126.5200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 11 11 25.393119 $2154.3600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 2.355023 $120.2800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 6 6 4.061111 $67.8200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 2.527245 $56.6100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.643912 $73.9800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.244444 $28.1100 $114.9800
EVAL -96111 DEVELOPMENTAL EVALUATION 34 36 34.874733 $1743.7300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 3 5.000000 $250.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 409 416 750.599022 $37529.9400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 13 22.872223 $1715.4200 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 10.005479 $750.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 30 30 52.243227 $2899.5000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 3.019330 $167.5700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 48 48 95.000000 $7125.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 41 41 78.106849 $5858.0100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 30 30 58.500000 $4387.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 7 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 11.505479 $862.9100 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 36 36 65.109589 $4883.2100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 100 102 182.834245 $10147.3000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 32 32 61.002740 $3385.6500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 42 46 90.076712 $6755.7500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.571429 $78.5700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 8 6.740476 $344.1000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 10 8.320548 $424.7600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 35 37 31.954664 $1631.2900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 6 6 2.072222 $105.7900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 2.477778 $126.4900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 22 27 35.503175 $1812.4400 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 66 73 44.687280 $2281.2800 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 2.000000 $102.1000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 2.466667 $125.9300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 7 7.000000 $311.8500 $44.5500
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Subtotal (Total Children Is Unduplicated) 1030 1348 1991.834528 $110167.2500 $55.3100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 38 46 44.682191 $223410.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.977777 $48.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 8 8 7.005023 $350.2600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 14.848413 $3415.1600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 821 1058 1035.916653 $51795.9600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 66 76 67.261608 $3363.1000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 170 193 120.544977 $3013.6800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1309 1410 2547.309325 $127365.4700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 76 78 94.079370 $4703.9900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 151 157 155.216665 $3880.4100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1075 1169 1655.203569 $82760.1800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 75 77 109.958725 $5497.9200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 60 84 80.116667 $2002.9200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 509 548 857.949450 $42897.5100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 49 49 56.685712 $2834.2800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 32 51 56.404169 $1410.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1625 1682 2309.513086 $115475.6300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 81 84 100.973015 $5048.6500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 151 156 147.653961 $3691.3300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 6 32.642857 $816.0700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 986 1073 7620.804695 $381040.4400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 50 51 316.392855 $15819.6600 $50.0000
INTR -T1013 INTERPRETER 174 212 669.429156 $33471.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3230 4287 24337.779076 $243377.9400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 106 114 718.545233 $51332.8700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 13.285715 $949.1300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 14 14 95.180953 $5444.3500 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 12.628571 $902.1900 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 14.276190 $1019.8900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 96 102 703.456344 $50254.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 13.810317 $789.4000 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 8.000000 $571.5200 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 2.266666 $161.9300 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 2.155555 $982.9100 $455.9900
SENS -V5264 EARMOLD 3 3 3.966666 $71.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 244 256 1857.465859 $132697.3600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 9 47.704761 $3408.0300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.285714 $130.7400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 9.428571 $673.5800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 38.647618 $2760.9900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 70.266667 $975.3000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 1112 1679 85860.170000 $38207.7800 $0.4500
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Subtotal (Total Children Is Unduplicated) 5615 14782 131914.890395 $1648934.3700 $12.5000
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Total 16421 134747.408647 $1760033.0100 $13.0600
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Number of Children (Unduplicated) With at Least One Authorization 6244