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 17845 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 308 311 414.553965 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.466667 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 6 6 139.477777 $5160.6700 $37.0000
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Subtotal (Total Children Is Unduplicated) 316 319 565.355552 $5525.3900 $9.7700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 142 154 132.571156 $6429.6900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 4.000000 $225.9600 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 14 14 15.000000 $352.3500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 3.800000 $90.0600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 5 2.007686 $18.2300 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 4 1.761111 $49.0100 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 0.946575 $80.3100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 2.246575 $114.7300 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 5 2.761111 $46.1100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 2.246575 $50.3200 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.407686 $63.3500 $45.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 27 30 37.979452 $1898.9800 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 5 9 18.000000 $900.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 366 370 659.994162 $32999.7200 $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 4 4 6.164384 $462.3300 $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 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 2.005479 $150.4100 $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 10 10 17.033333 $945.3500 $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 41 41 65.501367 $4912.6100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 27 27 51.819047 $3886.4300 $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 12 12 22.533333 $1690.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 47 47 81.282191 $6096.1700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 146 146 251.982511 $13985.0400 $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
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.833333 $41.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 5 2.300000 $117.4100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 5.108904 $260.8100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 38 39 32.683336 $1668.5000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 2.166667 $110.6100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 2.300000 $117.4200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 25 26 16.511110 $842.8900 $51.0500
SCREEN-T1023 SCREENING 4 4 5.000000 $250.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 3 3.000000 $153.1500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 4.000000 $204.2000 $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 59 63 47.743653 $2437.3200 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 10 10 8.988889 $458.8800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 8 7.594444 $338.3300 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.317808 $14.1600 $44.5500
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Subtotal (Total Children Is Unduplicated) 956 1238 1815.491419 $102473.7800 $56.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 20 21 17.264003 $86320.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.011111 $50.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 13 13 14.496574 $724.8300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 4.000000 $286.4400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 14.981745 $3445.7900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 782 966 866.596601 $43330.0000 $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 150 162 95.148432 $2378.7600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1530 1656 2813.073001 $140653.6100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 83 92 135.468254 $6773.4200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 188 198 156.762707 $3919.0900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1260 1404 2035.746805 $101787.2700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 114 116 142.266267 $7113.3100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 78 124 108.753177 $2718.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 536 597 871.451978 $43572.6100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 58 59 85.642462 $4282.1400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 38 64 71.092852 $1777.3100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1721 1781 2484.168251 $124208.4200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 144 147 166.857147 $8342.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 187 194 167.629767 $4190.7600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 17 17 54.428570 $1360.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1138 1306 8425.266128 $421263.3300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 53 53 322.470630 $16123.5300 $50.0000
INTR -T1013 INTERPRETER 169 196 710.184050 $35509.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3516 4544 26254.375433 $262543.8000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 109 115 645.689677 $46128.0900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 9 11 45.793650 $3271.4900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 7 7 27.214285 $1556.6600 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 5.142857 $367.4100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 13.892063 $992.4500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 88 94 570.529361 $40758.6300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 5 24.906349 $1779.3100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 7.785714 $445.0300 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 16.292064 $1163.9100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 17.060317 $1218.8000 $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 1 1 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 4 3.322222 $1514.9200 $456.0000
SENS -V5264 EARMOLD 6 6 9.033332 $162.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 228 242 1416.279351 $101179.0500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 12 13 90.928570 $6495.9400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 10 10 42.246031 $3018.0600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 43.714286 $606.7500 $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) 6311 16288 135855.366575 $1577826.3300 $11.6100
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Total 17845 138236.213546 $1685825.5000 $12.2000
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Number of Children (Unduplicated) With at Least One Authorization 6886