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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 37046 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 436 445 3583.671419 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 81 81 11939.207937 $444138.5300 $37.2000
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Subtotal (Total Children Is Unduplicated) 516 526 15522.879356 $444138.5300 $28.6100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 192 223 157.470891 $7637.3100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 36 37 26.869330 $1507.3700 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 403 443 471.728573 $9203.4300 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 24 24 23.100000 $546.7800 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 29 29 23.533257 $345.4700 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 119 120 67.991551 $1500.5700 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 24 25 18.583332 $133.8000 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 12 12 12.000000 $125.4000 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 33 34 25.049999 $724.4400 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 17 18 21.000000 $946.6800 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 43 43 35.399999 $488.8700 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 36 37 45.695238 $961.4300 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $61.0000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 1.100000 $95.6300 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 218 230 230.000000 $17279.9000 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 39 43 38.610730 $1749.8400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 14 8.929529 $1034.1500 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 35 44 54.961036 $2748.0500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 8 9 14.219178 $710.9600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 64 64 93.270994 $4663.5500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 16 21 38.320624 $2874.0500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 30 31 60.005479 $4500.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 18 18 30.010958 $2250.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 28.000000 $2100.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 9 9 13.005479 $975.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 14 28.000000 $2100.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 5 5 9.000000 $675.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 35 35 61.744031 $3426.7900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 16 18 30.505479 $1693.0600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 372 380 727.845983 $54588.4700 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 220 224 413.605174 $31020.3900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 100 100 194.500000 $14587.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 57 57 108.010958 $8100.8300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 122 123 239.285714 $17946.4300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 113 114 188.563010 $14142.2300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 573 579 1115.592689 $61915.4100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 287 290 521.700192 $28954.3700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 394 509 1006.000000 $75450.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 137 169 334.071429 $25055.3600 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 1 0.177778 $9.2200 $51.8600
MED -99204 OUTPATIENT VISIT, NEW, 45 MINS 1 1 0.888889 $99.4900 $111.9200
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 20 21 35.600002 $5063.4200 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 7.533333 $376.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 10 29.657143 $1482.8500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 128 131 58.106046 $2987.2400 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.216667 $11.1400 $51.4200
OCTH -97165 OT EVAL LOW COMPLEXITY 235 256 222.280908 $11427.4600 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 11 12 4.355556 $223.9200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 52 52 30.850227 $1586.0000 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 5 5 5.000000 $257.0500 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 3 3 1.327777 $68.2600 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 202 207 144.953173 $7452.0200 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 9 9 5.700001 $293.0400 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 8 8 2.378387 $122.2800 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 3 3 10.285714 $528.7900 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 81 85 49.452186 $2542.3400 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 0.238889 $12.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 90 95 56.434075 $2901.2900 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 3 2.383333 $122.5300 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 10 10 14.849206 $763.3900 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 38 38 21.557611 $1108.2800 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 3 1.266819 $65.1300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 125 134 87.503869 $4498.5800 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 5 5 2.604263 $133.8900 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 3 3 1.605556 $82.5400 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 3 3 2.022222 $103.9600 $51.4100
SCREEN-T1023 SCREENING 42 42 41.533333 $2076.6700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.986301 $14.9000 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 342 380 320.348048 $16469.1100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 4 4 1.661111 $85.4000 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 18 18 6.000001 $308.4700 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 23 23 18.774200 $965.1800 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 4 3.811111 $195.9300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 3 1.477778 $75.9700 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 1.022222 $52.5500 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 364 388 192.960489 $9920.0800 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 5.427778 $279.0400 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 5.344445 $274.7600 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 2.230593 $114.6800 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 1.377778 $70.8300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 32 33 25.273973 $1133.7900 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 16 16 84.076192 $4450.1500 $52.9300
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Subtotal (Total Children Is Unduplicated) 3847 6217 8043.315819 $486536.7300 $60.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 133 139 150.794729 $753973.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 28 28 23.989268 $1199.4600 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.811111 $56.2500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 4.180822 $289.9400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 34 34 28.147294 $6519.5000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1294 1609 1380.672196 $69033.7900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 111 125 74.178646 $3708.9200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 309 365 307.392760 $7684.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1795 2016 2972.062668 $148602.9900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 102 105 148.138890 $7406.9500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 123 137 140.966589 $3524.1600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1370 1533 1851.544446 $92577.2100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 39 41 46.042062 $2302.1000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 64 106 106.121429 $2653.0400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 667 750 942.015614 $47100.7300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 43 45 41.079364 $2053.9600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 22 39 33.438888 $835.9700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1984 2082 2457.958710 $122897.8300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 80 82 106.553175 $5327.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 118 124 135.608729 $3390.2200 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 36 38 634.857141 $15871.4400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 158 175 1287.642854 $32191.1000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1045 1190 8388.409951 $419420.5200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 2.285714 $114.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6086 6550 38198.506048 $1909924.7900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 464 494 2728.746852 $136437.2700 $50.0000
INTR -T1013 INTERPRETER 214 253 618.148339 $30907.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3628 4906 23629.532103 $236295.2400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1072 1196 6896.300032 $496257.5300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 22 24 132.942858 $9566.5700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 146 157 1140.594447 $65698.2700 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 3 3 21.214285 $1221.9400 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 61 63 322.049209 $23174.6500 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 10.285714 $740.1600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 1005 1153 5919.872238 $425993.6700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 17 17 81.630953 $5874.1500 $71.9600
PHY -97110HM PT SESSION BY PT ASST 71 76 420.115082 $24181.8100 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 3 10.785714 $620.8300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 54 58 222.944443 $16043.0500 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 11 11 61.176191 $4402.2200 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 2 2 11.142857 $641.3900 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 2 2 5.242857 $301.7800 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.164384 $18.8700 $114.8200
SENS -V5050 IN EAR MONAURAL HEARING AID 7 7 3.887063 $892.5400 $229.6200
SENS -V5060 BEHIND EAR HEARING AID 5 5 4.133333 $949.0500 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 11 11 8.788890 $4036.0800 $459.2300
SENS -V5264 EARMOLD 36 37 37.835085 $685.9500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1897 2186 12907.851745 $928848.6700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 48 52 275.928572 $19855.8100 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.350000 $20.1600 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 2.428571 $139.8900 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 67 71 397.131745 $28577.6000 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 14 14 68.771429 $4948.7900 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 14 17 91.642856 $1279.3400 $13.9600
TRAV -TRAVS Travel by mile 1465 2158 113428.013586 $50475.4700 $0.4500
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Subtotal (Total Children Is Unduplicated) 10464 30303 228923.050531 $6177747.2800 $26.9900
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Total 37046 252489.245706 $7108422.5400 $28.1500
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Number of Children (Unduplicated) With at Least One Authorization 12318