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: 01-01-21 and 03-31-21 Date of Report: 05-04-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 33783 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 304 319 852.716670 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 72 75 3837.501586 $141987.5700 $37.0000
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Subtotal (Total Children Is Unduplicated) 374 394 4690.218256 $141987.5700 $30.2700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 137 156 118.476494 $5746.1100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 10 10 8.698401 $491.3700 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 5.211111 $102.7100 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 352 354 390.067460 $9162.6900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 28 29 24.583333 $340.9700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 60 61 40.442239 $958.4800 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 28 29 21.955556 $199.3600 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 2.000000 $19.9200 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 44 45 40.133333 $1116.9100 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 11 11 15.000000 $577.0500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 38 38 36.383334 $3086.7700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 12 12 11.711111 $598.0900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 45 45 43.088889 $719.5800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 43 43 42.291248 $947.3200 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 26 26 14.128312 $635.7800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 16 17 9.527399 $1095.6500 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 27 31 29.271920 $1463.6100 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 3 6.000000 $300.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 416 418 705.666410 $35283.3000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 54 54 99.794367 $7484.5700 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 20 20 31.019330 $2326.4500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 4 4 4.011111 $300.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 8.005479 $600.4100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 12 12 22.000000 $1650.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 34 36 67.156165 $5036.7200 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 96 100 165.444586 $9182.1800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 9 9 16.000000 $888.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 480 480 925.318588 $69398.9000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 408 409 782.571228 $58692.8600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 231 231 458.566667 $34392.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 101 102 204.000000 $15300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 48 48 93.500000 $7012.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 195 196 348.584925 $26143.8900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 699 701 1308.564507 $72625.3400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 147 147 279.041093 $15486.7900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 300 317 568.322109 $42624.1700 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 11 12 22.000000 $1650.0000 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 9 9 12.133333 $606.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 63 64 17.444450 $890.5700 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 6 7 4.155555 $212.1400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 11 11 9.227778 $471.0800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 61 62 57.078202 $2913.8400 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 0.205555 $10.4900 $51.0400
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 0.298630 $15.2500 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 431 455 292.425860 $14928.3100 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 1.338889 $68.3500 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 4 4 0.541401 $27.6400 $51.0600
PSTF -97164 PT RE-EVAL EST PLAN CARE 33 34 7.205174 $367.8200 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 6 6 3.816666 $194.8400 $51.0500
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 3 3 0.349923 $17.8600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 4.155556 $212.1400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 35 35 23.575568 $1203.5200 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 0.348401 $17.7900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 265 279 180.542390 $9216.6900 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.120548 $6.1500 $51.0300
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.177778 $9.0800 $51.0600
SCREEN-T1023 SCREENING 52 52 49.111111 $2455.5600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 5 5.064384 $75.9700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 14 14 11.936508 $609.3600 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 3.000000 $153.1500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 16 16 13.719407 $700.3800 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.061111 $3.1200 $51.0400
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.038889 $1.9900 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 521 551 290.297542 $14819.6700 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 15 15 8.094443 $413.2100 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 18 18 10.115753 $516.4100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 60 61 60.455556 $3086.2600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 55 55 52.784680 $2351.5500 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.112329 $5.0000 $44.5400
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Subtotal (Total Children Is Unduplicated) 3732 5999 8100.475554 $491124.0200 $60.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 142 160 139.945586 $699728.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 13 14 15.329367 $766.4800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 38 40 33.760047 $1688.0100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 18 18 24.134921 $1728.3000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 45 46 47.767537 $10986.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 984 1285 1244.258662 $62213.1600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 74 82 52.806103 $2640.3200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 291 364 333.266896 $8331.7000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1607 1742 2645.309140 $132265.3700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 64 66 80.430954 $4021.5600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 169 176 161.070241 $4026.7700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1177 1343 1515.398025 $75769.9300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 64 65 89.224602 $4461.2300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 72 114 122.005553 $3050.1300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 633 692 919.025946 $45951.2300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 42 42 45.253968 $2262.7000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 33 59 62.250002 $1556.2600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1825 1902 2130.364287 $106518.2300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 88 90 95.587675 $4779.4100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 179 187 182.316272 $4557.9100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.000000 $73.3200 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 1.933333 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 197 223 1967.703971 $49192.5900 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 6.523810 $326.1900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5959 6466 38478.336729 $1923916.0700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 397 419 2243.242873 $112162.0800 $50.0000
INTR -T1013 INTERPRETER 233 280 813.818499 $40690.9200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3310 4561 23022.259662 $230222.5200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1109 1205 6062.969856 $433138.5400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 42 42 192.393653 $13744.5900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 197 213 1068.770633 $61133.6500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 6 6 35.357142 $2022.4300 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 7 7 35.480952 $2534.7600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 44 46 211.550793 $15113.2000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1022 1088 5500.190112 $392933.4200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 38 39 198.063495 $14149.6300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 56 60 313.450001 $17916.7800 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 5 17.214286 $983.9600 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 8 9 41.699999 $2979.0600 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 38 39 209.526985 $14968.5800 $71.4400
RSPT -RSPT RESPITE 1 1 1.142857 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 3.319634 $215.7700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.027397 $3.1200 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 10 11 11.270473 $2569.6700 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 6 8 5.821461 $1327.2800 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 10 10 8.277777 $3774.6300 $456.0000
SENS -V5264 EARMOLD 47 50 34.179912 $615.2400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1980 2151 11491.630025 $820961.9400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 75 82 296.548239 $21185.3900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 21.142858 $1209.3700 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.000000 $343.2000 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 24 25 169.042858 $12076.4200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 45 50 289.757147 $20700.2200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 55 56 309.116668 $4290.5400 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 17.714286 $245.8700 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 5 6 5.607937 $207.4900 $37.0000
TRAV -TRAVS Travel by mile 1045 1729 85086.771203 $37863.6100 $0.4500
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Subtotal (Total Children Is Unduplicated) 9305 27390 188119.363300 $5433167.3900 $28.8800
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Total 33783 200910.057110 $6066278.9800 $30.1900
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Number of Children (Unduplicated) With at Least One Authorization 10911