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 19315 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 326 331 1075.971627 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 127.833333 $4729.8300 $37.0000
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Subtotal (Total Children Is Unduplicated) 336 342 1208.338293 $4897.5600 $4.0500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 124 135 105.599814 $5121.5800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 6.088888 $339.2100 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 2.761111 $64.8900 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 34 34 34.784921 $817.4500 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 2.383333 $34.7500 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 7 4.222222 $99.2200 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 7 2.477777 $24.2600 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $9.7900 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 9 9 4.544444 $130.5200 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 2.377778 $106.4300 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 0.481963 $40.8800 $84.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 10 10 6.477777 $88.8100 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 2.811111 $58.7200 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 8 10.006382 $450.2800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.000000 $230.0000 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 41 45 57.654566 $2882.7300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 8 9 16.355556 $817.7800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 162 163 255.929169 $12796.4700 $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 5 5 9.000000 $675.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 4 4 7.000000 $525.0000 $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 15 16 26.002740 $1443.1500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 44 44 76.521916 $5739.1500 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 58 58 104.008219 $7800.6200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 35 35 67.500000 $5062.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 4 4 7.000000 $525.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 11 11 18.502740 $1387.7000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 33 33 58.508219 $4388.1200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 135 135 255.524656 $14181.6200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 69 70 127.016438 $7049.4100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 44 49 97.500000 $7312.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 9 3.722223 $190.0200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 10 10 16.711111 $853.1000 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 5.703968 $291.1900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 82 86 94.789316 $4839.0000 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 2.172223 $110.9000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.150000 $58.7100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.077778 $55.0200 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 34 34 19.226180 $981.5000 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 2.000000 $30.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 9.533334 $486.6800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.438889 $22.4100 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.1000 $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 54 55 38.271432 $1953.7700 $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 12 13 13.000000 $663.6500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 28 28 21.024602 $936.6400 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 7.142857 $375.5000 $52.5700
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Subtotal (Total Children Is Unduplicated) 868 1203 1641.288986 $94256.4200 $57.4300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 40 44 47.733637 $238668.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 14 15 14.211112 $710.5600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 9 6.990107 $481.3400 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 18 18 12.938889 $2975.9500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1043 1317 1133.360220 $56668.2800 $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 220 238 127.987966 $3199.7400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1757 1973 3236.080734 $161803.9400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 120 126 231.502381 $11575.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 163 188 153.465081 $3836.6300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1342 1506 1952.371414 $97618.5400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 141 148 164.403972 $8220.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 80 135 124.472226 $3111.8200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 548 605 823.555215 $41177.7100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 54 56 53.966669 $2698.3500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 22 41 28.877773 $721.9300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1907 2009 2392.692038 $119634.5200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 146 151 155.627778 $7781.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 169 188 167.028573 $4175.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 6 47.000000 $1175.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 105 113 769.120633 $38456.0500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1570 1737 10705.366669 $535268.1400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 60 63 336.458731 $16822.9400 $50.0000
INTR -T1013 INTERPRETER 183 209 595.401075 $29770.0500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3311 4122 23161.403785 $231613.9100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 165 176 1046.261914 $74744.9100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 4 5 9.590476 $685.1400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 18 19 93.071428 $5323.6900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 6.500000 $371.8000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 3.714286 $265.3500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 8 9 31.480953 $2249.0000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 134 145 860.688495 $61487.5800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 1.574603 $112.4900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 7 42.928571 $2453.8000 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 15.552380 $1111.0600 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 2.000000 $130.0000 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 2.100000 $957.6000 $456.0000
SENS -V5264 EARMOLD 9 9 4.059589 $73.0700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 321 347 2221.457935 $158700.8400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 7 13.606349 $972.0300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 11.571429 $661.8800 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.166667 $83.3500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 14 14 64.861905 $4633.7400 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 5 5 45.285715 $628.5700 $13.8800
TRAV -TRAVS Travel by mile 1267 1796 90991.296822 $40491.1200 $0.4500
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Subtotal (Total Children Is Unduplicated) 7124 17770 142046.566963 $1981270.3600 $13.9500
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Total 19315 144896.194242 $2080424.3400 $14.3600
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Number of Children (Unduplicated) With at Least One Authorization 7787