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: 04-01-21 and 06-30-21 Date of Report: 07-15-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 33908 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 344 356 422.681739 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 6.000000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 77 77 6399.253174 $236772.3700 $37.0000
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Subtotal (Total Children Is Unduplicated) 420 434 6827.934913 $236772.3700 $34.6800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 152 168 133.596877 $6479.4600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 15 15 13.615525 $769.1400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 6 6 4.050000 $79.8300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 281 282 290.672918 $6827.9100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 28 28 24.011112 $333.0400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 45 45 31.450001 $745.3700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 35 35 22.324964 $202.7100 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 38 38 25.138891 $699.6200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 9 9 9.700000 $373.1600 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 35 36 47.314645 $4014.1800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 11 11 18.873375 $963.8600 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 41 41 49.683334 $829.7100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 29 29 25.786075 $577.6100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 30 30 19.254186 $866.4300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 16 16 10.869788 $1250.0400 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 28 31 76.871037 $3843.5600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 7 11 21.000000 $1050.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 409 412 719.913712 $35995.7000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 9 16.000000 $1200.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 38 38 70.500000 $5287.5000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 30 31 58.010958 $4350.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 7 7 11.357143 $851.7800 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 12 12 18.013698 $1351.0300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 22 23 43.500000 $3262.5000 $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 67 72 127.738813 $7089.5000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 20 20 38.002740 $2109.1500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 506 508 973.677166 $73025.8100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 458 459 872.491190 $65436.8500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 199 200 396.285714 $29721.4300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 117 117 233.000000 $17475.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 58 58 108.000000 $8100.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 214 215 386.995889 $29024.6800 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 869 876 1604.124839 $89028.9700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 241 241 465.956555 $25860.5900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 371 384 657.292488 $49296.9800 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 12 12 24.000000 $1800.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.133333 $6.6700 $49.9900
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 3 3.733333 $186.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 59 59 17.078341 $871.8400 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 5 5 1.194444 $60.9700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 13 13 9.811111 $500.8600 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.005556 $0.2900 $51.4600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 75 77 58.467970 $2984.7900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 406 429 273.145859 $13944.0900 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 5 5 2.563547 $130.8700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 29 29 8.910885 $454.9100 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 3 3 0.794444 $40.5500 $51.0500
PSTF -97164TL 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 46 48 33.516210 $1711.0000 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 1.361111 $69.4800 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.126027 $6.4300 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 229 247 139.027736 $7097.3700 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 3 3 1.052359 $53.7200 $51.0500
SCREEN-T1023 SCREENING 51 53 54.000000 $2700.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.966667 $29.5000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 14 14 10.710426 $546.7700 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 25 25 22.459523 $1146.5600 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 549 572 328.384643 $16764.0600 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 17 17 7.338889 $374.6500 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.216667 $113.1600 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 19 19 19.247260 $982.5700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 72 73 75.080158 $3832.8400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 62 62 45.226943 $2014.8700 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 2.313470 $103.0600 $44.5500
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Subtotal (Total Children Is Unduplicated) 3840 6307 8786.940545 $538182.7000 $61.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 161 178 283.851781 $1419258.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 9 7.455556 $372.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 32 33 79.642423 $3982.1300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 12 12 24.097619 $1725.6300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 45 46 69.622222 $16013.1100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 886 1140 1098.613914 $54930.8900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 111 146 117.677635 $5883.8800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 261 319 251.044223 $6276.1500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1522 1679 2537.606726 $126880.3700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 80 84 128.092061 $6404.6000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 165 178 159.369848 $3984.2600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1205 1372 1766.060987 $88303.0900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 87 94 116.287693 $5814.3700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 76 119 141.114281 $3527.8500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 539 586 765.103177 $38255.1700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 55 57 76.668647 $3833.4100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 34 56 68.292855 $1707.3200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1778 1869 2310.169666 $115508.5200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 117 124 132.398412 $6619.9100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 175 187 201.577781 $5039.4500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.288889 $21.1800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 206 247 2549.000004 $63724.9900 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 2.466667 $123.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5860 6371 38897.057737 $1944852.7000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 541 568 3207.795258 $160389.6800 $50.0000
INTR -T1013 INTERPRETER 203 227 827.022147 $41351.1400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3341 4547 23247.217998 $232472.1600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1042 1129 6222.263530 $444518.4000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 50 53 241.134132 $17226.6300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 174 185 1236.168854 $70708.8800 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 8 8 52.816668 $3021.1100 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 11 11 32.516666 $2322.9900 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 62 65 276.655560 $19764.2800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 926 1002 5156.173848 $368356.9600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 45 51 195.518256 $13967.8100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 56 57 302.573813 $17295.1100 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 4 35.142857 $2008.7600 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 8 8 27.639682 $1974.5800 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 56 62 310.847623 $22206.9600 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 8 8 4.807153 $312.4600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 5.316742 $1212.2100 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 3 2.233333 $509.1900 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 12 12 15.688889 $7154.1400 $456.0000
SENS -V5264 EARMOLD 37 37 59.116514 $1064.1000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1931 2119 11542.285785 $824580.7000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 81 86 418.919846 $29927.6700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 9 23.892064 $1366.6200 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 18 18 125.409524 $8959.2500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 89 98 515.222222 $36807.4900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 50 55 269.981215 $3747.3400 $13.8800
TRAV -TRAVS Travel by mile 1165 1830 87453.526192 $38916.8200 $0.4500
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Subtotal (Total Children Is Unduplicated) 9228 27167 193592.447175 $6295258.1000 $32.5200
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Total 33908 209207.322633 $7070213.1700 $33.8000
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Number of Children (Unduplicated) With at Least One Authorization 11107