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 18405 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 293 307 826.673813 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 11 11 491.576191 $18188.3200 $37.0000
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Subtotal (Total Children Is Unduplicated) 304 318 1318.250004 $18188.3200 $13.8000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 120 138 105.357923 $5109.8500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.9800 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.211111 $4.1600 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 223 224 240.496825 $5649.2700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 8 5.011110 $69.5000 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 5.000000 $118.5000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 8 9 5.294443 $48.0700 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 2.000000 $19.9200 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 9 10 6.294443 $175.1700 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 4.000000 $153.8800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 12 12 8.788890 $745.6600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 1.333333 $68.0900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 10 10 8.494444 $141.8600 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 9 7.472222 $167.3800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 1.142620 $51.4300 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 1.728007 $198.7300 $115.0100
EVAL -96111 DEVELOPMENTAL EVALUATION 26 29 25.271920 $1263.6100 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 3 6.000000 $300.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 405 407 687.666410 $34383.3000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 8 8 13.511111 $1013.3300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $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 3 3 6.500000 $487.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 30 30 51.132420 $2837.8500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 7.000000 $388.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 62 62 116.000000 $8700.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 55 55 107.505479 $8062.9100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 32 32 64.000000 $4800.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 9 9 18.000000 $1350.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 48 48 89.516437 $6713.7400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 116 117 217.820939 $12089.0700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 30 30 56.010958 $3108.6100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 34 36 73.000000 $5475.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 6 6 2.083333 $106.3500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 1.227778 $62.6800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 10 11 8.385464 $428.0800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 36 37 22.585843 $1153.0000 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.019178 $0.9800 $51.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 4 0.205556 $10.5000 $51.0600
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 3.344444 $170.7300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 24 25 40.847619 $2085.2800 $51.0500
SCREEN-T1023 SCREENING 5 5 5.000000 $250.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 3.211111 $163.9300 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 57 60 30.269024 $1545.2300 $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 6 6 5.455556 $278.5100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.033333 $90.5800 $44.5500
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Subtotal (Total Children Is Unduplicated) 1174 1509 2105.229284 $112808.9600 $53.5900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 37 41 37.918339 $189591.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 2.766667 $138.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 11 12 8.429222 $421.4600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 11 12 20.134127 $4630.8700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 879 1137 1068.471230 $53423.7800 $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 172 190 160.307345 $4007.7200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1591 1724 2627.286920 $131364.2700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 64 66 80.430954 $4021.5600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 167 174 159.875797 $3996.9100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1160 1326 1495.909953 $74795.5300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 64 65 89.224602 $4461.2300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 71 113 121.005553 $3025.1300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 621 679 906.292613 $45314.5700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 42 42 45.253968 $2262.7000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 30 56 58.288891 $1457.2300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1807 1884 2118.019844 $105901.0100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 88 90 95.587675 $4779.4100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 176 184 176.316272 $4407.9100 $25.0000
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 1.933333 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 11 24.132539 $603.3200 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 5.857143 $292.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1275 1384 8002.285759 $400114.1700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 81 84 420.741277 $21037.0400 $50.0000
INTR -T1013 INTERPRETER 215 261 768.012149 $38400.6100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3308 4556 23007.183470 $230071.7500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 140 151 654.823020 $46780.5500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 1.388889 $99.2200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 27 28 134.163493 $7674.1500 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 8.714286 $622.5500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 114 119 652.311114 $46601.0800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 17.857143 $1020.7200 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 3 24.571428 $1755.3900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 2.288888 $163.5100 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 3.596500 $820.0200 $228.0100
SENS -V5060 BEHIND EAR HEARING AID 2 4 2.766666 $630.7800 $227.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 0.444444 $202.6500 $455.9500
SENS -V5264 EARMOLD 10 11 5.440944 $97.9400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 296 315 1565.192861 $111817.3300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 7 28.835714 $2060.0200 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 17.428571 $1245.1000 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 4 24.857143 $1775.7900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 30.790477 $427.3700 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.000000 $83.2800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 5 6 5.607937 $207.4900 $37.0000
TRAV -TRAVS Travel by mile 1044 1725 85074.161678 $37858.0000 $0.4500
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Subtotal (Total Children Is Unduplicated) 6390 16578 129817.712941 $1593240.6900 $12.2700
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Total 18405 133241.192229 $1724237.9700 $12.9400
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Number of Children (Unduplicated) With at Least One Authorization 7165