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: 04-01-22 and 06-30-22 Date of Report: 08-08-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 37837 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 12.821429 $474.3900 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 403 417 1117.011901 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 72 72 4841.433333 $179133.0300 $37.0000
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Subtotal (Total Children Is Unduplicated) 476 491 5971.266663 $179607.4200 $30.0800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 190 222 166.358812 $8068.3800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 27 27 22.722222 $1265.8500 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 264 294 297.211111 $6984.4600 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 324 325 325.968254 $7660.2500 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 20 20 15.644443 $228.0900 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 66 66 45.422591 $1067.4300 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 35 35 19.749206 $193.3400 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 8 8 8.000000 $78.3200 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 40 41 25.354761 $728.1800 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 12 12 11.027778 $493.6000 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 4.060882 $344.5200 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 46 46 33.438095 $458.4400 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 39 39 41.852381 $874.2900 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 30 30 21.784399 $980.3000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 28 28 17.010732 $1956.2500 $115.0000
BEHV -H2014BA Behavior Analysis - Technician 1 1 13.428571 $654.7800 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 25 30 43.802892 $2190.1500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 9 10 20.000000 $1000.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 114 114 168.571158 $8428.5600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 38 54 102.434051 $7682.5500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 23 24 41.022222 $3076.6700 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 25 25 43.024962 $3226.8700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 10 10 19.000000 $1425.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 21.524962 $1614.3700 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 15 15 22.527778 $1689.5900 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 14 38.357142 $2876.7900 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 7 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 39 39 71.027626 $3942.0400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 27.000000 $1498.5000 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 454 459 855.597624 $64169.8400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 441 443 843.187944 $63239.0900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 147 148 286.066667 $21455.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 62 63 119.000000 $8925.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 132 133 256.008220 $19200.6100 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 154 154 272.195771 $20414.6900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 702 709 1354.089405 $75151.9800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 396 396 743.273984 $41251.7100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 288 313 613.066667 $45980.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 121 130 257.502740 $19312.7000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 8 13.628571 $681.4300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 107 110 55.277129 $2821.9100 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.255556 $13.0500 $51.0600
OCTF -97168TL OT RE-EVAL EST PLAN CARE 2 2 0.194445 $9.9300 $51.0600
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 1 1 0.833333 $42.5400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 143 171 145.283334 $7416.7200 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 0.266667 $13.6200 $51.0600
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 2 2 1.884921 $96.2200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 50 50 37.423103 $1910.4500 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.255556 $13.0500 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 335 339 252.809097 $12905.9200 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 6 6 3.750000 $191.4400 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 2.188889 $111.7400 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 3 3 12.897619 $658.4200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 62 62 24.098554 $1230.2300 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 0.283333 $14.4600 $51.0400
PSTH -97161 PT EVAL LOW COMPLEXITY 56 65 44.354186 $2264.2800 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 35 36 32.803870 $1674.6400 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 1.388889 $70.9000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 198 204 140.840903 $7189.9400 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 1.411111 $72.0400 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
SCREEN-T1023 SCREENING 56 59 57.894445 $2894.7300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 5 14.200630 $213.0100 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 141 163 147.798769 $7545.1100 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 9 9 9.000000 $459.4500 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 19 19 27.643150 $1411.1800 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 0.433333 $22.1200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 442 463 233.753194 $11933.0800 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 14 14 5.307685 $270.9500 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 4.494444 $229.4400 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 2.717123 $138.7100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 62 62 63.429366 $3238.0700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 124 127 95.821112 $4268.8300 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 2.000000 $89.1000 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 12 12 83.161906 $4371.8200 $52.5700
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Subtotal (Total Children Is Unduplicated) 3965 6554 8845.100276 $528666.8600 $59.7700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 128 143 130.239225 $651195.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 69 71 64.395748 $3219.7900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 19 20 23.176191 $1595.9100 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 56 56 56.489530 $12992.6100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1246 1550 1342.244660 $67112.5700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 134 160 109.198840 $5459.9300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 354 426 329.333388 $8233.4000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1765 1962 3083.180155 $154158.9800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 105 117 201.851188 $10092.5500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 145 152 159.244441 $3981.1000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1437 1616 1981.656338 $99082.7600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 116 120 111.841268 $5592.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 86 141 136.423807 $3410.5900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 597 686 929.814868 $46490.6800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 58 61 66.819841 $3340.9900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 36 60 58.055551 $1451.3800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1942 2047 2526.158310 $126307.8500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 154 158 134.183727 $6709.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 155 162 169.461904 $4236.5500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 12 13 94.642857 $2366.0700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 212 273 2150.535726 $53763.3400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 569 628 3805.792438 $190289.6000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 3 10.714287 $535.7100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6650 7237 44446.804653 $2222339.7200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 580 600 2730.219865 $136510.9900 $50.0000
INTR -T1013 INTERPRETER 220 262 576.296672 $28814.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3389 4289 22498.921887 $224989.2000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1209 1412 8070.366682 $576546.9500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 28 29 133.219048 $9517.1700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 207 227 1364.849206 $78069.4000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 7 7 45.785714 $2618.9400 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 28 28 151.350796 $10812.5200 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 59 61 263.901591 $18853.1300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1056 1258 6660.843685 $475850.3500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 20 21 101.066668 $7220.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 123 132 624.621431 $35703.3500 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 7 7 30.357142 $1735.2200 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 30 30 106.180955 $7585.5700 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 51 51 180.261909 $12877.9200 $71.4400
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 9.714286 $555.2700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.122222 $7.9400 $64.9900
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.010959 $1.2500 $114.4300
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 0.772603 $176.1500 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 8 8 5.425114 $1236.9200 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 14 14 12.938889 $5900.1400 $456.0000
SENS -V5264 EARMOLD 49 49 52.617984 $947.1300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1999 2317 12962.153620 $926016.1500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 46 54 213.923810 $15282.6900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 9 32.142857 $1838.5700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 38 38 207.792064 $14844.6600 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 76 82 406.492862 $29039.8800 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 56 65 332.750003 $4618.5600 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.000000 $69.4000 $13.8800
TRAV -TRAVS Travel by mile 1311 1871 101465.576402 $45152.1900 $0.4500
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Subtotal (Total Children Is Unduplicated) 10646 30792 221367.935867 $6357351.4200 $28.7200
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Total 37837 236184.302806 $7065625.7100 $29.9200
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Number of Children (Unduplicated) With at Least One Authorization 12529