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 21417 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 412 420 3416.699990 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 19 19 681.688888 $25358.8200 $37.2000
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Subtotal (Total Children Is Unduplicated) 431 439 4098.388878 $25358.8200 $6.1900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 173 200 131.116402 $6359.1300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 4 0.627778 $35.2200 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 57 59 67.301587 $1313.0500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 3.000000 $71.0100 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $29.3600 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 9 3.750000 $82.7600 $22.0700
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.4500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 5 3.611111 $104.4300 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 5.000000 $225.4000 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 7 7 5.611111 $77.4900 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 5.000000 $105.2000 $21.0400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 23 23 23.000000 $1727.9900 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 7 4.572222 $207.2100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.305556 $151.2000 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 27 35 45.938814 $2296.9400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 7 8 12.219178 $610.9600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 60 60 88.626550 $4431.3300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 8 14.115068 $1058.6300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 5 5 6.010958 $450.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 6.005479 $450.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 13.571429 $753.2100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 7 9 15.505479 $860.5600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 67 68 127.796672 $9584.7500 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 45 47 83.016437 $6226.2400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 19 19 37.000000 $2775.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 12 12 22.005479 $1650.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 34 35 66.785714 $5008.9300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 30 31 50.519177 $3788.9400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 126 126 238.982190 $13263.5200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 75 76 134.530135 $7466.4300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 47 54 105.500000 $7912.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 21 26 51.000000 $3825.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 1 1 5.400000 $768.0400 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 7.533333 $376.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 8.638095 $431.9000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 17 17 7.221919 $371.2800 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 54 56 49.368255 $2538.0200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 4.183333 $215.0600 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 31 32 28.378595 $1458.9500 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.411111 $21.1300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.138889 $7.1400 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 15 16 8.926790 $458.9300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 11 11 7.855556 $403.8600 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.383333 $19.7100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.350000 $17.9900 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 0.538889 $27.7000 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 16 16 16.861111 $866.8300 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.093151 $4.7900 $51.4400
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.188889 $9.7100 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 4 4 4.000000 $200.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 99 104 102.987304 $5294.5900 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.072222 $3.7100 $51.3900
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.071233 $55.0700 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 49 50 31.349097 $1611.6600 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.872222 $44.8400 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.411111 $21.1300 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.011111 $0.5700 $51.3600
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 7 14.272222 $640.2500 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $189.0300 $52.9300
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Subtotal (Total Children Is Unduplicated) 942 1314 1692.613726 $99741.2100 $58.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 27 37.198849 $185994.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 13 13 9.833333 $491.6700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 7.523016 $1742.5000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1190 1472 1243.306865 $62165.5300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 110 124 72.178646 $3608.9200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 207 221 155.334822 $3883.3700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1776 1994 2956.757113 $147837.7200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 102 105 148.138890 $7406.9500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 121 134 140.408294 $3510.2100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1354 1517 1839.216667 $91960.8100 $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 658 740 929.354503 $46467.6800 $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 1949 2046 2420.019027 $121000.8400 $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 4 4 37.857142 $946.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 3.428572 $85.7100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 908 1035 7620.857176 $381042.8700 $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 1382 1482 8750.470256 $437523.4000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 81 84 458.459532 $22922.9500 $50.0000
INTR -T1013 INTERPRETER 199 236 584.112625 $29205.6300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3628 4905 23617.103532 $236170.9500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 202 218 1433.085721 $103124.8000 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.866667 $134.3300 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 18 19 135.357144 $7796.5700 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 5.266667 $378.9900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 187 203 1040.240480 $74855.6100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 1.857143 $133.6400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 4 4 22.000000 $1266.3200 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 2.000000 $115.1200 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 13.714286 $986.8800 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 1.428571 $82.2300 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.066667 $15.3200 $229.7200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 0.422223 $193.9300 $459.3000
SENS -V5264 EARMOLD 3 3 5.838889 $105.8600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 415 452 2642.446843 $190150.3600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 8 37.876191 $2725.5600 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 37.857142 $528.4900 $13.9600
TRAV -TRAVS Travel by mile 1465 2158 113428.013586 $50475.4700 $0.4500
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Subtotal (Total Children Is Unduplicated) 7987 19664 170312.026441 $2233715.3000 $13.1200
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Total 21417 176103.029045 $2358815.3300 $13.3900
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Number of Children (Unduplicated) With at Least One Authorization 8729