Summary Report for FSPSAs Initiated During the Report Period Statewide
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting between: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 10941 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 2.866667 $106.0700 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 240 242 678.202381 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 241 243 681.069048 $106.0700 $0.1600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 110 126 87.772298 $4256.9600 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 3.000000 $70.5000 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 3.000000 $70.5000 $23.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 25 29 43.466514 $2173.3300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 9 10 18.355556 $917.7800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 99 100 161.020167 $8051.0100 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
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 6 10.005479 $750.4100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 12.000000 $900.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 1.500000 $112.5000 $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 11.505479 $638.5600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 8 16.000000 $1200.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.183333 $9.3600 $51.0400
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 1.444444 $73.7400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 7 3.483333 $177.8200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.183333 $9.3600 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 1.272223 $64.9500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 2.433333 $124.2200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 2.350000 $119.9700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.483333 $110.6300 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.000000 $52.5700 $52.5700
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Subtotal (Total Children Is Unduplicated) 291 343 401.458825 $21231.1500 $52.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 7.750000 $38750.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 5 4.644444 $232.2200 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.561111 $129.0500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 710 859 705.609417 $35280.6900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 92 118 85.030950 $4251.5500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 134 140 91.818189 $2295.4700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1143 1255 2010.875007 $100543.8200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 72 73 121.466671 $6073.3500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 132 145 151.501590 $3787.5500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 890 972 1256.062287 $62803.0400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 83 90 75.023014 $3751.1500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 72 111 106.475393 $2661.8700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 370 408 526.040085 $26302.0400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 38 38 44.679364 $2233.9700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 19 34 35.069447 $876.7400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1195 1256 1575.482148 $78774.1100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 96 101 94.550795 $4727.5500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 133 150 143.843652 $3596.0900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 139 176 701.838883 $35091.9300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 45 51 376.428571 $18821.4300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 13.857142 $692.8600 $50.0000
INTR -T1013 INTERPRETER 158 178 513.074885 $25653.7400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2200 2812 14700.155921 $147001.6600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 26 28 146.216668 $10445.7300 $71.4400
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 5.571429 $318.6800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 1.142857 $81.6500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 6.966667 $497.7000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 34 39 180.747619 $12912.6000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 14.142857 $808.4100 $57.1600
SENS -V5264 EARMOLD 1 1 0.644444 $11.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 35 169.928569 $12139.7200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.642857 $331.6900 $71.4400
TRAV -TRAVS Travel by mile 872 1261 73098.910510 $32529.0100 $0.4500
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Subtotal (Total Children Is Unduplicated) 4426 10355 96970.753443 $674408.6400 $6.9500
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Total 10941 98053.281316 $695745.8500 $7.1000
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Number of Children (Unduplicated) With at Least One Authorization 4721