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 18985 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 324 326 955.943652 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 43.733333 $1618.1300 $37.0000
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Subtotal (Total Children Is Unduplicated) 328 330 1002.543652 $1724.2000 $1.7200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 161 190 126.961082 $6157.6300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 9 6.638890 $369.8600 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 11 11 11.000000 $258.5000 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 19 19 17.966666 $422.2200 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 3.000000 $43.7400 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 4.488889 $105.4900 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 7 3.072222 $30.0800 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 2.000000 $19.5800 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 9 4.472222 $128.4400 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 4.000000 $179.0400 $44.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 7 8 4.072222 $55.8300 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 6.744444 $140.8900 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 2.066667 $93.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 3.000000 $345.0000 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 37 41 57.955403 $2897.7700 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 10 11 20.355556 $1017.7800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 141 142 225.163024 $11258.1500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 11.000000 $825.0000 $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 2 2 3.000000 $225.0000 $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 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 13 14 21.091629 $1170.5800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $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 60 60 106.087671 $7956.5800 $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 5 5 8.000000 $600.0000 $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 73 74 133.016438 $7382.4100 $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 5 6 1.927778 $98.4100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 28 31 33.488889 $1709.6100 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 9 7.650000 $390.5300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 55 59 53.644173 $2738.5300 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 1.955556 $99.8300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 6 6 2.727777 $139.2500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 4.088889 $208.7400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 1.533333 $78.2800 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 29 30 49.128570 $2508.0100 $51.0500
SCREEN-T1023 SCREENING 4 4 4.000000 $200.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 25 27 37.213492 $1899.7400 $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 43 47 34.106347 $1741.1200 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $153.1500 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 16 17 15.583333 $795.5300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 23 25 43.921428 $1956.7000 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 10 10 44.066666 $2316.6000 $52.5700
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Subtotal (Total Children Is Unduplicated) 861 1252 1737.246787 $99445.9400 $57.2400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 34 40 33.723896 $168619.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 10 10 9.327777 $466.3900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 13.591270 $935.9000 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 9.454762 $2174.5800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1053 1294 1118.081855 $55904.4000 $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 229 242 143.990745 $3599.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1709 1875 2983.112513 $149155.7100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 100 109 184.331750 $9216.6000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 190 206 208.979371 $5224.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1332 1473 1888.176572 $94408.7500 $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 546 603 852.794050 $42639.7200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 50 51 56.857141 $2842.8500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 24 40 40.691670 $1017.3000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1856 1961 2469.143253 $123457.1400 $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 1 1 10.428571 $260.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 12.000000 $300.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 225 283 1176.740468 $58837.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1398 1577 10161.780886 $508089.3100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 69 72 320.787298 $16039.3900 $50.0000
INTR -T1013 INTERPRETER 183 207 560.215362 $28010.7700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3077 3948 20537.351099 $205373.6400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 154 172 921.747625 $65849.6300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 4.619047 $329.9800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 17 18 135.071428 $7726.1000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 5.571429 $318.6800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 3 3 28.857143 $2061.5600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 8 8 40.906350 $2922.3500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 133 154 819.546817 $58548.4700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 16.357143 $1168.5500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 7 33.428572 $1910.7800 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 5.100000 $364.3400 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 6 6 33.540476 $2396.1300 $71.4400
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 4.857143 $277.6300 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 6 6 8.677777 $156.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 295 323 2001.477763 $142985.6500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 8 8 23.099206 $1650.2100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 7.285714 $416.7400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 2.933333 $209.5600 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 6 8 32.195238 $2300.0300 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 8.000000 $111.0400 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.428571 $19.8300 $13.8800
TRAV -TRAVS Travel by mile 1281 1832 97521.441040 $43397.0400 $0.4500
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Subtotal (Total Children Is Unduplicated) 7063 17403 145181.126543 $1840115.9300 $12.6700
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Total 18985 147920.916982 $1941286.0700 $13.1200
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Number of Children (Unduplicated) With at Least One Authorization 7595