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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 36398 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 3 3 4.533333 $167.7300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 348 354 1157.372418 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 70 70 4359.957937 $161318.4500 $37.0000
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Subtotal (Total Children Is Unduplicated) 420 427 5521.863688 $161486.1800 $29.2400
Screening, Eval, and Assessment, Class # 02
AACRS -92597GN AAC RE-EVAL BY LICENSED SLP 1 1 1.000000 $52.6300 $52.6300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 142 154 115.860622 $5619.2300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 27 27 23.492922 $1308.7900 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 47 47 46.216667 $1086.0900 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 559 564 605.815080 $14236.6600 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 18 18 15.833334 $230.8500 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 70 70 51.700069 $1214.9600 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 32 32 22.366665 $218.9700 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 5 5 5.000000 $48.9500 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 41 41 28.394444 $815.4900 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 16 16 16.800001 $751.9700 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 16 16 12.609741 $1069.8100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 10 10 8.166667 $417.0700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 51 51 40.288888 $552.3600 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 54 54 64.486507 $1347.1200 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 36 38 36.811176 $1656.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 11 9.899239 $1138.4100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 45 55 68.776788 $3438.8400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 10 12 22.355556 $1117.7800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 164 166 261.929169 $13096.4700 $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 31 32 58.694444 $4402.0800 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 21 21 34.033333 $2552.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 19 19 37.000000 $2775.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 16.000000 $1200.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 17 17 26.027701 $1952.0800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 9 18.000000 $1350.0000 $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 53 57 99.532866 $5524.0700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 13 13 21.230289 $1178.2800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 442 444 843.576706 $63268.2800 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 382 382 722.507612 $54188.0600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 216 217 425.000000 $31875.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 50 51 98.000000 $7350.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 56 56 101.013699 $7576.0200 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 177 177 315.677105 $23675.7700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 766 771 1473.865161 $81799.5200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 275 276 506.547946 $28113.4000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 334 361 697.431311 $52307.3500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 39 39 75.500000 $5662.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.633333 $81.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 6 22.371428 $1118.5800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 76 77 38.377779 $1959.1900 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.383333 $19.5700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 31 33 37.088888 $1893.3800 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 0.688889 $35.1700 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 66 66 41.379464 $2112.4300 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 497 525 391.313036 $19976.5400 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 2.405556 $122.8100 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 42 42 18.372225 $937.9200 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.422222 $21.5500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 16 17 9.600002 $490.0900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 47 48 31.844444 $1625.6600 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 239 251 150.229664 $7669.2600 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.366667 $18.7200 $51.0500
SCREEN-T1023 SCREENING 39 42 49.428571 $2471.4300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 4 6.642857 $99.6400 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 45 48 42.107143 $2149.5700 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 15 15 13.994444 $714.4100 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 2.084932 $106.4300 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.283333 $14.4600 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 526 561 327.992335 $16744.0200 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 1.914385 $97.7400 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.077778 $55.0200 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 13 13 4.756165 $242.8100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 78 84 75.133333 $3835.5600 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.155556 $7.9400 $51.0600
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 155 160 120.111135 $5350.9600 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.109589 $4.8800 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.158904 $7.0800 $44.5800
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 7 7 37.771428 $1985.6500 $52.5700
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Subtotal (Total Children Is Unduplicated) 3961 6374 8473.640526 $499038.5600 $58.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 125 136 120.589564 $602948.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 7 8.588888 $429.4400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 45 47 46.756896 $2337.8600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 35 36 56.257199 $3873.8700 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 74 75 67.776028 $15588.4800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1143 1447 1259.135424 $62957.0600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 144 195 133.780768 $6689.0300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 354 425 330.061260 $8251.5700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1783 2001 3260.995019 $163049.6500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 120 126 231.502381 $11575.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 167 192 156.859525 $3921.4900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1364 1528 1971.015858 $98550.7600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 141 148 164.403972 $8220.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 81 136 124.688893 $3117.2300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 558 615 834.925058 $41746.2100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 54 56 53.966669 $2698.3500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 24 43 31.955550 $798.8800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1928 2033 2420.292830 $121014.5600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 146 151 155.627778 $7781.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 172 191 170.167462 $4254.1900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 4.857143 $121.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 213 233 2232.000007 $55799.9900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 107 115 783.482537 $39174.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6685 7349 46167.840514 $2308391.0600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 561 600 2778.511917 $138925.5500 $50.0000
INTR -T1013 INTERPRETER 209 240 658.105837 $32905.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3312 4125 23177.403785 $231773.9100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1169 1282 7148.921445 $510718.8100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 40 45 181.442855 $12962.2600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 208 224 1472.304769 $84215.8100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 12 13 55.309524 $3163.7000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 21 23 69.592065 $4971.6500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 81 93 354.247622 $25307.4600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1015 1123 5770.232948 $412225.3200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 28 31 151.350792 $10812.5100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 97 107 635.785718 $36341.4800 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 4 16.376190 $936.0600 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 19 20 87.961904 $6284.0000 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 55 56 286.049204 $20435.3100 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 3.000000 $195.0000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5060 BEHIND EAR HEARING AID 4 4 4.013699 $915.1200 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 9 9 5.822222 $2654.9200 $456.0000
SENS -V5264 EARMOLD 38 39 33.441259 $601.9400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2006 2229 12807.449625 $914963.9000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 61 65 315.982542 $22573.7800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 9 9 43.571430 $2492.2800 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 28 29 203.152382 $14513.1900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 94 98 488.298415 $34884.0200 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 36 38 205.785714 $2856.3100 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.466667 $62.0000 $13.8800
TRAV -TRAVS Travel by mile 1267 1799 91027.868251 $40507.4000 $0.4500
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Subtotal (Total Children Is Unduplicated) 10353 29597 208774.976004 $6142603.4200 $29.4200
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Total 36398 222770.480218 $6803128.1600 $30.5400
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Number of Children (Unduplicated) With at Least One Authorization 12170