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: 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 33300 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 1 1 9.857143 $364.7100 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 333 338 479.366662 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.466667 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 100 101 9186.453968 $339898.8000 $37.0000
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Subtotal (Total Children Is Unduplicated) 435 441 9677.144440 $340263.5100 $35.1600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 154 166 139.609436 $6771.0500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 23 23 23.044444 $1301.7800 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 9 9 10.000000 $197.1000 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 170 170 169.963699 $3992.4500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 29 29 24.172222 $335.2700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 50 50 36.711112 $870.0600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 35 36 23.074352 $209.5100 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 8 8 9.000000 $89.6400 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 39 40 29.055554 $808.6100 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 12 12 14.000000 $538.5800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 37 38 35.746574 $3032.7300 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 16 16 17.246575 $880.7800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 42 43 29.966666 $500.4400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 56 56 63.415622 $1420.5100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 27 27 18.087214 $813.9200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 17 17 9.319862 $1071.7700 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 30 33 42.979452 $2148.9800 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 5 9 18.000000 $900.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 376 380 676.494162 $33824.7200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 8 14.000000 $1050.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 36 36 64.664384 $4849.8300 $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 6 6 17.000000 $1275.0000 $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 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 13 13 18.369862 $1377.7400 $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 59 64 115.648402 $6418.4800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 20 20 36.358904 $2017.9200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 508 510 977.677166 $73325.8100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 451 452 858.806259 $64410.4800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 199 200 396.819047 $29761.4300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 115 115 229.000000 $17175.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 60 60 111.533333 $8365.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 211 212 379.316437 $28448.7200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 876 883 1605.037166 $89079.6100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 243 243 467.962034 $25971.9000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 378 391 660.347672 $49526.1300 $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 2.900000 $145.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 3 8.928571 $446.4300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 69 71 38.775734 $1979.5000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 12 12 8.916667 $455.2000 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.477778 $24.3900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 88 93 75.395356 $3848.9300 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.500000 $25.5300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 357 379 252.107966 $12870.1000 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.005556 $0.2900 $51.4600
PSTF -97164 PT RE-EVAL EST PLAN CARE 41 42 12.832880 $655.1300 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.177778 $9.0800 $51.0600
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 52 54 36.738583 $1875.5000 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 2.428571 $123.9800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 224 250 154.871117 $7906.1400 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.127778 $6.5200 $51.0600
SCREEN-T1023 SCREENING 50 52 52.500000 $2625.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 3.933333 $59.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 11 12 11.122222 $567.7900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 25 25 25.251587 $1289.0900 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 482 528 292.010012 $14907.1600 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 3.194445 $163.0800 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.216667 $62.1100 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 14 14 7.990106 $407.9000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 61 63 58.313492 $2976.9000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 60 62 46.699791 $2080.4700 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.317808 $103.2600 $44.5500
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Subtotal (Total Children Is Unduplicated) 3549 6132 8585.672368 $529139.8300 $61.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 116 126 138.848716 $694243.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 12 11.222223 $561.1200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 37 39 43.396572 $2169.8200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.833333 $131.2800 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 27 27 57.883594 $4145.0500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 51 52 57.301075 $13179.2300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 843 1039 944.523434 $47226.3500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 111 143 105.273667 $5263.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 260 322 261.991445 $6549.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1550 1678 2826.800778 $141340.0000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 83 92 135.468254 $6773.4200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 193 203 161.384929 $4034.6400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1277 1422 2047.874582 $102393.6500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 114 116 142.266267 $7113.3100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 79 125 109.036510 $2725.9200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 544 605 878.740868 $43937.0600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 58 59 85.642462 $4282.1400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 40 66 72.642852 $1816.0600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1744 1805 2506.346029 $125317.3100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 144 147 166.857147 $8342.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 193 200 175.368655 $4384.2300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 170 206 1129.714288 $28242.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5798 6403 41902.999751 $2095150.4100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 548 582 3089.207100 $154460.3200 $50.0000
INTR -T1013 INTERPRETER 190 218 752.803097 $37640.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3518 4546 26266.661147 $262666.6600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 915 1022 5760.281679 $411514.7300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 59 63 291.457140 $20821.7000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 150 161 1008.607137 $57692.3700 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 8 9 28.357142 $1622.0300 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 10 10 35.314284 $2522.8500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 66 69 332.157933 $23729.3800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 747 840 4641.786462 $331609.4700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 39 44 214.999207 $15359.5400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 58 61 446.071425 $25497.4600 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 2 16.428571 $939.0600 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 18 19 65.521428 $4680.8600 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 61 68 281.184127 $20087.8400 $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 5 5 3.574429 $814.9600 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 4 4 5.744445 $1309.7500 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 12 13 11.600000 $5289.6000 $456.0000
SENS -V5264 EARMOLD 36 37 37.081276 $667.4600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1716 1905 11054.270901 $789717.5400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 59 64 358.443646 $25607.2700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 7 31.320635 $1791.5500 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 19 19 114.469843 $8177.7300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 111 118 605.298406 $43242.5500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 56 59 375.675392 $5214.3700 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.857143 $81.3000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.666667 $24.6700 $37.0000
TRAV -TRAVS Travel by mile 1270 1891 86741.603024 $38600.0100 $0.4400
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Subtotal (Total Children Is Unduplicated) 9002 26727 196540.861117 $5640771.3800 $28.7000
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Total 33300 214803.677925 $6510174.7200 $30.3100
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Number of Children (Unduplicated) With at Least One Authorization 10184