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: 07-01-21 and 09-30-21 Date of Report: 10-13-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 11389 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 241 252 1390.484133 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 156.416667 $5787.4200 $37.0000
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Subtotal (Total Children Is Unduplicated) 243 254 1546.900800 $5787.4200 $3.7400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 96 101 88.238204 $4279.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 69 69 68.700000 $1613.7600 $23.4900
EVAL -96111 DEVELOPMENTAL EVALUATION 26 30 41.879300 $2093.9700 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 1 1 2.000000 $100.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 176 178 306.399981 $15320.0100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 6 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $777.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 4 8.000000 $600.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 1.561111 $79.6900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.194444 $9.9200 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 0.827778 $42.2600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 1.316667 $67.2200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 6 6.959525 $355.2900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 11 11 6.200000 $316.5100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 406 444 595.282489 $29062.6900 $48.8200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.866667 $24333.5000 $5000.0300
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.472222 $73.6100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.243836 $17.4600 $71.6000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 610 755 649.814008 $32490.8200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 73 95 62.448777 $3122.4400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 91 99 70.584617 $1764.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1054 1163 2033.939286 $101696.9300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 55 59 94.125399 $4706.2900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 129 145 139.755554 $3493.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 915 1030 1413.296016 $70664.7000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 72 74 83.928572 $4196.4300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 73 119 100.255555 $2506.3900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 378 425 620.447218 $31022.3200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 45 46 58.337302 $2916.8700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 34 60 62.172225 $1554.3100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1192 1259 1658.394445 $82919.7400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 92 98 110.564287 $5528.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 132 147 137.599205 $3439.9800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 10 54.214287 $1355.3600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 95 105 741.768261 $37088.4100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 10 10 52.957143 $2647.8600 $50.0000
INTR -T1013 INTERPRETER 166 202 588.225396 $29411.2800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2588 3375 19381.788236 $193817.8800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 24 27 128.071430 $9149.4100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.000000 $228.8000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 4.357143 $249.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 13 14 61.719048 $4409.2100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.357143 $311.2700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 16.285714 $930.9000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.466667 $95.3400 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 25 27 141.885715 $10136.3100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 10.571428 $755.2200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 8.642858 $119.9600 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.666667 $24.6700 $37.0000
TRAV -TRAVS Travel by mile 872 1326 74210.986025 $33023.8900 $0.4500
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Subtotal (Total Children Is Unduplicated) 4263 10691 102715.208352 $700433.4700 $6.8200
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Total 11389 104857.391641 $735283.5800 $7.0100
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Number of Children (Unduplicated) With at Least One Authorization 4590