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 18138 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 322 334 374.069834 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 7 7 165.711111 $6131.3100 $37.0000
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Subtotal (Total Children Is Unduplicated) 329 341 539.780945 $6131.3100 $11.3600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 138 151 120.693453 $5853.6400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.222222 $24.0900 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 156 156 166.381517 $3908.3000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 7 6.066666 $84.1400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 6 4.077778 $96.6400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 9 4.480517 $40.6800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 8 8 3.477777 $96.7800 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 3.222222 $123.9600 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 9 18.914644 $1604.7100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 2.252740 $115.0500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 6 6 2.633333 $43.9800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 3.502740 $78.4600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 2.041629 $91.8700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 4.000000 $460.0000 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 26 29 72.871037 $3643.5600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 7 11 21.000000 $1050.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 398 401 703.413712 $35170.7000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 13 13 22.123744 $1227.8700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 55 55 103.572146 $7767.9200 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 43 43 69.186298 $5188.9800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 26 26 49.285714 $3696.4300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 11 11 20.000000 $1500.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 49 49 84.967122 $6372.5300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 143 143 251.505800 $13958.5900 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 45 45 83.810958 $4651.5100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 38 39 76.510958 $5738.3300 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 5 2.661904 $135.8900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 1.156164 $59.0200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 54 54 30.836759 $1574.2200 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.024658 $1.2600 $51.1400
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 1.222222 $62.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 4 1.638888 $83.6600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 31 32 25.794445 $1316.8100 $51.0500
SCREEN-T1023 SCREENING 5 5 6.000000 $300.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 72 75 37.038702 $1890.8200 $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 9 9 10.122222 $516.7400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 9 9 9.138889 $407.1400 $44.5500
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Subtotal (Total Children Is Unduplicated) 1146 1465 2069.860538 $111820.3100 $54.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 40 45 152.512403 $762561.0000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 2.366667 $118.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 12 12 11.580518 $579.0300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 11 11 14.440476 $3321.2900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 823 1063 1010.442636 $50522.3100 $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 153 167 97.334543 $2433.4100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1500 1655 2514.890061 $125744.5500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 80 84 128.092061 $6404.6000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 163 176 158.269848 $3956.7600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1190 1354 1750.105965 $87505.3400 $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 526 573 752.198413 $37609.9200 $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 1754 1843 2290.633747 $114531.7400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 117 124 132.398412 $6619.9100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 172 184 195.211114 $4880.2900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.288889 $21.1800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.714286 $17.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1193 1294 7310.336569 $365516.7300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 72 73 415.700795 $20785.0500 $50.0000
INTR -T1013 INTERPRETER 182 206 790.022147 $39501.1400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3341 4546 23238.217998 $232382.1600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 120 127 752.826988 $53781.9500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 7 7 24.871429 $1776.8100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 11 90.142859 $5156.1600 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 1.200000 $85.7300 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 4.952381 $353.8000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 112 118 585.678176 $41840.8700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 3 4.916667 $351.2500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 10.073810 $575.8200 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 2.577778 $184.1600 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.233333 $53.1900 $227.9700
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 5 5.688889 $2594.1400 $456.0000
SENS -V5264 EARMOLD 6 6 7.000000 $126.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 283 300 1636.153982 $116886.8300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 13 15 76.961907 $5498.1800 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 14.571428 $1040.9800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 7 8 40.760316 $2911.9200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 6 7 43.142857 $598.8200 $13.8800
TRAV -TRAVS Travel by mile 1165 1829 87444.526192 $38912.8200 $0.4500
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Subtotal (Total Children Is Unduplicated) 6263 16332 132235.077651 $2159036.4300 $16.3300
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Total 18138 134844.719134 $2276988.0600 $16.8900
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Number of Children (Unduplicated) With at Least One Authorization 7043