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
Eligibility Filter: Program Patients
With the filters selected there were 35057 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 2 2 11.866667 $439.0700 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 350 352 1059.213493 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 48 48 3573.833333 $132231.8300 $37.0000
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Subtotal (Total Children Is Unduplicated) 400 402 4644.913493 $132670.9000 $28.5600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 179 210 143.475019 $6958.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 30 30 31.312385 $1744.4300 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 129 133 141.242063 $3319.1900 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 268 271 270.333333 $6352.8300 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 25 25 24.616437 $358.9100 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 100 100 66.294110 $1557.9200 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 36 37 35.298412 $345.5700 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 15 15 15.000000 $146.8500 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 40 42 37.448412 $1075.5200 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 19 19 19.000000 $850.4400 $44.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 58 59 54.020635 $740.6200 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 50 51 49.366589 $1031.2700 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 18 20 16.597337 $746.8800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 25 25 23.447184 $2696.4300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 40 50 67.077625 $3353.8800 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 12 14 26.355556 $1317.7800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 143 145 230.163024 $11508.1500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 32 33 61.511111 $4613.3300 $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 18 18 34.000000 $2550.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 20.000000 $1500.0000 $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 51 53 96.920548 $5379.0900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 13 13 23.011111 $1277.1200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 441 444 844.862420 $63364.7000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 382 382 724.112330 $54308.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 218 219 429.000000 $32175.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 52 53 100.000000 $7500.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 56 56 99.128767 $7434.6500 $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 767 772 1472.065161 $81699.6200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 279 280 512.547946 $28446.4000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 335 362 699.431311 $52457.3500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 39 39 75.500000 $5662.5000 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 5 10.938096 $546.9100 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 86 90 59.430954 $3033.9700 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 2 2 0.216667 $11.0600 $51.0600
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 99 109 88.272756 $4506.3300 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 0.600000 $30.6300 $51.0500
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 68 69 46.132570 $2355.0500 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 2.138888 $109.1900 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.061111 $3.1200 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 376 393 319.455653 $16308.2100 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 7 7 6.165080 $314.7300 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 6 6 5.553968 $283.5300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 43 43 18.866664 $963.1300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 42 50 25.939269 $1324.2000 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 3 1.344444 $68.6300 $51.0500
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 41 43 25.380821 $1295.6800 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 186 197 140.948128 $7195.3900 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 58 59 65.789682 $3289.4900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 15.642857 $234.6400 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 102 110 106.176981 $5420.3200 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 16 16 14.683333 $749.5800 $51.0500
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 0.172222 $8.7900 $51.0400
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 18 18 15.150229 $773.4200 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 1.022222 $52.1800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 429 471 252.000117 $12864.6000 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 4.243302 $216.6200 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.377778 $121.3900 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 12 12 5.736454 $292.8500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 70 74 65.333333 $3335.2600 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 135 142 138.806283 $6183.8200 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 0.460578 $20.5200 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 49 52 248.003170 $13037.5400 $52.5700
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Subtotal (Total Children Is Unduplicated) 3617 6227 8552.081686 $508720.9200 $59.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 127 139 106.642844 $533214.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 43 44 62.687637 $3134.3700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 7.903175 $544.2100 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 17 18 24.291803 $1672.7300 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 60 60 61.702500 $14191.5300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1155 1426 1251.357059 $62568.1900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 146 197 136.302991 $6815.1500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 363 424 337.068344 $8426.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1730 1897 3006.516480 $150325.9100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 100 109 184.331750 $9216.6000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 192 208 210.479371 $5262.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1346 1487 1898.998795 $94949.8700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 117 124 109.048409 $5452.4100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 93 145 132.675392 $3316.8700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 558 615 866.094050 $43304.7200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 50 51 56.857141 $2842.8500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 26 42 42.891670 $1072.3000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1880 1986 2494.782142 $124739.0800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 146 153 140.844448 $7042.2400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 196 219 213.553179 $5338.8400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 9 9 58.857141 $1471.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 110 117 1606.428565 $40160.7300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 251 310 1202.757925 $60137.9000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6316 6959 45092.673805 $2254634.8300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 613 648 2805.286472 $140264.4200 $50.0000
INTR -T1013 INTERPRETER 207 241 631.510600 $31575.5400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3077 3948 20537.351099 $205373.6400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1043 1143 6727.835681 $480636.8200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 35 39 100.152377 $7154.8800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 166 185 1374.423809 $78617.0500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 8 8 50.428573 $2884.5100 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 28 30 117.057934 $8362.6400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 54 63 279.619046 $19976.0100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 938 1062 5756.385704 $411236.3500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 25 26 117.611110 $8402.1400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 87 94 570.083333 $32585.9600 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 6 6 36.514285 $2087.1600 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 34 34 109.263491 $7805.8100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 51 52 217.824603 $15561.3800 $71.4400
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 4.857143 $277.6300 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.010959 $2.5100 $228.8500
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.232877 $281.1000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 11 11 9.422223 $4296.5700 $456.0000
SENS -V5264 EARMOLD 38 38 53.284681 $959.1200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1808 2003 11834.552681 $845460.9100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 60 63 254.589675 $18187.9000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 26.714285 $1528.0600 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 31 31 124.171426 $8870.8100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 87 91 447.670634 $31981.5900 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 27 29 210.485712 $2921.5500 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 4.571428 $63.4500 $13.8800
TRAV -TRAVS Travel by mile 1281 1832 97521.441040 $43397.0400 $0.4500
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Subtotal (Total Children Is Unduplicated) 9936 28428 209230.099497 $5850588.4900 $27.9600
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Total 35057 222427.094676 $6491980.3100 $29.1900
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Number of Children (Unduplicated) With at Least One Authorization 11006