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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 18778 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 0.788889 $29.1900 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 368 374 1084.084134 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 9 9 1157.788888 $42838.1900 $37.0000
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Subtotal (Total Children Is Unduplicated) 378 384 2242.661911 $42867.3700 $19.1100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 143 159 110.226200 $5345.9700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 6 7.000000 $389.9700 $55.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 22 22 22.194444 $521.5700 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 2.783333 $40.5800 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.644444 $38.6400 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 1.988889 $19.4700 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $9.7900 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 1.988889 $57.1200 $28.7200
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 5 1.688888 $143.2800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 2.000000 $102.1400 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 1.400000 $19.1900 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 10.285714 $214.8700 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.344444 $60.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.117808 $13.5500 $114.9900
EVAL -96111 DEVELOPMENTAL EVALUATION 22 24 32.286756 $1614.3400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 6.011111 $300.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 265 268 471.522832 $23576.1400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 10.233334 $767.5100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 8.188889 $614.1700 $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 2.016590 $151.2500 $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 19 21 38.122146 $2115.7800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 6.005479 $333.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 60 60 120.000000 $9000.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 44 44 80.060275 $6004.5200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 26 26 50.966667 $3822.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 8 8 14.566667 $1092.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 16.966667 $1272.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 26 26 46.008220 $3450.6100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 102 103 198.675733 $11026.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 46 46 80.085846 $4444.7600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 34 36 71.142857 $5335.7200 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.142857 $7.1500 $50.0200
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.716667 $35.8400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 6 7 3.983333 $203.3500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 9 4.344445 $221.7900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 59 61 41.031484 $2094.6600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 3 2.222222 $113.4400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 5 4.388889 $224.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 34 41 30.647618 $1564.5500 $51.0500
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 4.411111 $225.1900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 54 57 29.309523 $1496.2500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $153.1500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 13 14 12.722222 $649.4700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 13 13 13.168255 $586.6500 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 0.432877 $19.2900 $44.5500
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Subtotal (Total Children Is Unduplicated) 853 1148 1589.044625 $90800.3900 $57.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 24 26 24.593009 $122965.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 2.488889 $124.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 14 14 24.579366 $1228.9700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 3.161111 $217.6700 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 14 14 19.431746 $4469.3100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 911 1140 1033.959486 $51698.1900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 155 201 156.392479 $7819.6500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 176 188 120.343336 $3008.6200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1658 1828 3000.495830 $150024.7400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 105 120 169.689681 $8484.4800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 170 183 155.611905 $3890.3000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1324 1481 1968.261509 $98413.0700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 138 140 189.285714 $9464.2900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 80 132 84.879356 $2121.9600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 560 609 810.257548 $40512.9100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 68 71 81.397620 $4069.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 58 61.611108 $1540.2700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1853 1957 2486.000374 $124300.0300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 162 168 186.740471 $9337.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 169 174 149.968257 $3749.2100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 6 26.678571 $666.9700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1454 1553 9838.212318 $491910.5600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 59 62 293.886508 $14694.3200 $50.0000
INTR -T1013 INTERPRETER 185 198 676.040962 $33802.0500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3558 4503 24281.497465 $242814.9800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 109 113 635.604762 $45407.6100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 12 12 51.117459 $3651.8300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 11 11 71.857144 $4110.2300 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 14.057143 $1004.2400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 6 6 129.142857 $9225.9700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 97 106 505.019845 $36078.5900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 7 7 23.238096 $1660.1300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 9 62.071430 $3548.0000 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 4.000000 $285.7600 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 12.380952 $884.4900 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 2.076712 $473.4900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.955556 $217.8800 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 6 5.322222 $2426.9200 $456.0000
SENS -V5264 EARMOLD 8 8 4.237823 $76.2800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 245 265 1299.486516 $92835.3100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 15 16 59.342858 $4239.4400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 9 9 52.449999 $3747.0300 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 7 8 53.523810 $742.9100 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 2.333333 $86.3300 $37.0000
TRAV -TRAVS Travel by mile 1270 1827 102937.657514 $45807.2600 $0.4500
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Subtotal (Total Children Is Unduplicated) 6969 17246 151771.340650 $1687838.5500 $11.1200
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Total 18778 155603.047186 $1821506.3200 $11.7100
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Number of Children (Unduplicated) With at Least One Authorization 7604