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: 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 18646 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 3 3 3.311112 $122.5100 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 291 295 1099.539679 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 12 12 952.219048 $35232.1100 $37.0000
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Subtotal (Total Children Is Unduplicated) 306 310 2055.069839 $35354.6200 $17.2000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 132 152 113.578993 $5508.5800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 3 3.000000 $169.4700 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.305556 $6.0200 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 101 101 98.882877 $2322.7600 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 5 2.172222 $30.1300 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 5 2.172222 $19.7200 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 4 1.172222 $32.6200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $38.4700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 8 8 4.488889 $380.8400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 2.305556 $38.5000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 2.038889 $45.6700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 0.933333 $42.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.016667 $231.9200 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 21 24 25.955405 $1297.7800 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 399 400 675.097969 $33754.8700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 10.311111 $773.3300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 3 3 4.000000 $300.0000 $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 -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.500000 $337.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 26 26 45.665753 $2534.4500 $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 61 61 115.000000 $8625.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 57 57 111.505479 $8362.9100 $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 21.857143 $1639.2800 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 50 50 93.516437 $7013.7400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 117 118 229.678082 $12747.1300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 29 29 54.010958 $2997.6100 $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
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 2.366667 $118.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.100000 $5.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 0.505556 $25.8100 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 6.735541 $343.8500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 57 59 47.450413 $2422.3500 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.227397 $11.6100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 1.172222 $59.8400 $51.0500
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 4.000000 $204.2000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 25 27 16.867048 $861.0700 $51.0500
SCREEN-T1023 SCREENING 10 10 10.000000 $500.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 62 70 35.575975 $1816.1600 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 6 6 6.000000 $306.3000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 11 11 9.550000 $425.4500 $44.5500
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Subtotal (Total Children Is Unduplicated) 1071 1377 1956.716582 $110171.1700 $56.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 30 33 35.528919 $177644.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 11 12 14.455555 $722.7800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.005479 $72.0000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 14 15 18.211111 $4188.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 919 1186 1094.004737 $54700.4200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 74 82 58.864436 $2943.2300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 171 186 120.618059 $3015.4900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1559 1691 2817.691254 $140884.5100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 76 78 112.051589 $5602.5800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 201 205 201.449999 $5036.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1305 1470 1956.344811 $97817.1300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 67 69 70.911112 $3545.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 98 158 146.977782 $3674.4600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 532 586 833.638092 $41681.9000 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 49 49 72.972218 $3648.5900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 37 65 44.638883 $1115.9600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1849 1924 2488.883732 $124444.2400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 95 98 116.865875 $5843.3000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 215 223 209.338093 $5233.4500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 8 18.464285 $461.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1225 1382 8112.914981 $405645.8100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 49 52 281.442851 $14072.1400 $50.0000
INTR -T1013 INTERPRETER 209 259 946.846274 $47342.3200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3580 4722 25064.986941 $250649.9400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 116 121 673.019836 $48080.5100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 13 14 102.928572 $5887.5100 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 17.123810 $1223.3200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 95 100 582.850788 $41638.8800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.900000 $207.1800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 3 15.571428 $890.0600 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 5.500000 $314.3800 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 11.428571 $816.4600 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 11.390476 $813.7300 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.011111 $65.7200 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 2.016667 $459.8100 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 3 1.866666 $425.5800 $227.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.866667 $1307.2200 $456.0100
SENS -V5264 EARMOLD 6 7 5.172221 $93.1000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 249 266 1692.308713 $120898.5600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 7 49.976190 $3570.3100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.142857 $122.5700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 4 18.142857 $1296.1300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 5.714286 $408.2300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 41.847620 $580.8500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 3 4 1.142858 $42.2800 $37.0000
TRAV -TRAVS Travel by mile 1190 1852 89140.484215 $39667.5100 $0.4400
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Subtotal (Total Children Is Unduplicated) 6396 16959 137226.513477 $1668796.5800 $12.1600
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Total 18646 141238.299898 $1814322.3700 $12.8500
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Number of Children (Unduplicated) With at Least One Authorization 7024