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
Eligibility Filter: Program Patients
With the filters selected there were 18739 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 327 341 1499.284131 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 2.733333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 15 16 1179.600794 $43645.2300 $37.0000
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Subtotal (Total Children Is Unduplicated) 343 358 2681.618258 $43645.2300 $16.2800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 131 138 115.179299 $5586.1900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.9800 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.522223 $10.2900 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 77 77 76.222223 $1790.4600 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 2.188890 $30.3600 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.000000 $47.4000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 7 3.890945 $35.3300 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 5 2.638890 $73.4400 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $38.4700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 7 8 3.413167 $289.5800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 1.252055 $63.9400 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 2.972223 $49.6400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 4.252055 $95.2500 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 6 2.263167 $101.8500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.305556 $35.1400 $115.0200
EVAL -96111 DEVELOPMENTAL EVALUATION 32 37 49.657078 $2482.8600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 6.388889 $319.4500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 238 240 406.209798 $20310.5000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 6.005479 $450.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $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 20.683257 $1147.9200 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 2.005556 $111.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 67 68 129.010958 $9675.8300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 64 65 117.290410 $8796.7900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 19 19 36.033333 $2702.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 8.000000 $600.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 46 46 81.295889 $6097.2000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 132 133 247.167121 $13717.7800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 58 58 102.032874 $5662.8300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 48 51 103.000000 $7725.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.466667 $23.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 2.466667 $123.3400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 7 7 3.566667 $182.0800 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 4.294444 $219.2300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 47 49 31.805556 $1623.6800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 4 2.644445 $135.0000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.433333 $73.1700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 24 24 18.697348 $954.5100 $51.0500
SCREEN-T1023 SCREENING 6 6 6.000000 $300.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 2.000000 $30.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $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 69 71 48.635704 $2482.8600 $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 6 6 6.000000 $306.3000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 12 12 11.044444 $492.0300 $44.5500
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Subtotal (Total Children Is Unduplicated) 931 1226 1712.936610 $97863.5900 $57.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 20 21 18.154871 $90774.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.033333 $51.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 16 17 40.502849 $2025.1500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 2.243836 $160.6800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 11 11 12.472222 $2868.6100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 907 1138 1002.759228 $50138.1300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 120 160 106.821760 $5341.0900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 142 153 96.739942 $2418.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1559 1715 3036.686108 $151834.2600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 93 97 145.189683 $7259.5000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 183 203 182.437299 $4560.9300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1359 1529 2125.388086 $106269.3200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 101 103 113.250796 $5662.5500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 93 157 134.700000 $3367.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 549 609 899.055948 $44952.7300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 56 57 73.203969 $3660.2000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 73 74.127780 $1853.2000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1868 1967 2666.743659 $133337.2100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 137 143 172.569843 $8628.4900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 186 205 188.599203 $4714.9700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 22 24 118.464290 $2961.6000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1266 1389 8891.527839 $444576.3000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 61 63 394.807939 $19740.4000 $50.0000
INTR -T1013 INTERPRETER 188 228 638.225396 $31911.2800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3582 4697 27016.793844 $270167.9300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 100 107 608.692856 $43485.0100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 39.266668 $2805.2100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 8 8 44.500001 $2545.4000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 4.357143 $249.2300 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 8.142857 $581.7300 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 7 8 28.227778 $2016.6000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 89 92 602.950796 $43074.8000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 7 7 35.225397 $2516.5000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 18.285714 $1045.2200 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 0.785714 $44.9100 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 21.095238 $1507.0500 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 4.466667 $290.3400 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.305556 $69.6800 $228.0300
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.666667 $380.0100 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 9 11 9.955557 $179.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 234 253 1524.046039 $108877.8600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 12 12 58.680952 $4192.1700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.142857 $65.3700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 9.428571 $673.5800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 9.973015 $712.4700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 43.157143 $599.0200 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.000000 $180.4400 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.666667 $24.6700 $37.0000
TRAV -TRAVS Travel by mile 1217 1856 93762.199322 $41724.1800 $0.4500
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Subtotal (Total Children Is Unduplicated) 6636 17155 145003.718898 $1657533.3200 $11.4300
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Total 18739 149398.273766 $1799042.1400 $12.0400
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Number of Children (Unduplicated) With at Least One Authorization 7302