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: 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 20566 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 344 345 2379.549197 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 25 25 3068.033335 $114130.8500 $37.2000
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Subtotal (Total Children Is Unduplicated) 369 370 5447.582532 $114130.8500 $20.9500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 119 151 126.495598 $6135.0500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 21 21 20.383333 $1143.5000 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 4.055556 $79.1200 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.055556 $1.3200 $23.6900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.422223 $20.8800 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.511112 $11.2800 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 0.872223 $6.2800 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 5 2.872223 $83.0700 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.055556 $2.5100 $45.1100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 10 10 8.505556 $117.4600 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 5.422223 $114.0900 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.000000 $86.9400 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 59 62 62.000000 $4658.0600 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 8 4.563471 $206.8200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 1.391249 $161.1300 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 29 36 49.481355 $2474.0700 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 5 6 12.000000 $600.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 47 47 66.893217 $3344.6600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 9 16.115068 $1208.6300 $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 8 8 14.000000 $777.0000 $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 68 70 131.796672 $9884.7500 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 47 49 87.016437 $6526.2400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 20 20 39.000000 $2925.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 13 13 24.005479 $1800.4100 $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 32 33 54.519177 $4088.9400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 127 127 242.516437 $13459.6700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 76 77 136.530135 $7577.4300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 48 55 107.500000 $8062.5000 $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 2 2 1.722222 $244.9500 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 3.666666 $183.3300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 2.433333 $121.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 24 25 10.038889 $516.1000 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 63 68 69.986509 $3598.0100 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.333333 $17.1400 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 12 9.524962 $489.6800 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.186301 $9.5800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 27 27 14.318950 $736.1400 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 2 0.361111 $18.5600 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 12 15 7.277778 $374.1500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 16 17 23.165078 $1190.9100 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.127778 $6.5700 $51.4200
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.500000 $25.7100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.478996 $127.4500 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.186301 $9.5800 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 18 19 14.555557 $748.3100 $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
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 107 121 100.131523 $5147.7900 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 6 6 1.355555 $69.6900 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 1.250000 $64.2600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 35 41 19.444717 $999.6500 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.258523 $13.2900 $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 0.066667 $3.4300 $51.4300
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.7200 $44.8600
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Subtotal (Total Children Is Unduplicated) 868 1297 1664.440275 $101790.8000 $61.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 34 37 40.863056 $204314.0000 $4999.9700
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.955556 $916.2000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1218 1502 1326.351112 $66317.7300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 109 121 83.401861 $4170.0800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 207 219 169.625158 $4240.6300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1662 1827 2920.168067 $146008.4600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 91 92 134.985717 $6749.2900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 109 116 136.196521 $3404.9200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1336 1474 1926.259536 $96313.0400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 53 56 70.213492 $3510.6800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 67 104 110.470778 $2761.7600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 601 666 910.255569 $45512.8500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 42 44 56.261110 $2813.0500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 30 51 57.022218 $1425.5500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1807 1894 2250.945230 $112547.2300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 83 84 131.906349 $6595.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 96 96 133.540477 $3338.5100 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 12.571428 $314.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 20.142858 $503.5700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 953 1083 8256.406745 $412820.3100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 0.928571 $46.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1206 1340 8677.378608 $433868.7100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 118 122 796.266677 $39813.3100 $50.0000
INTR -T1013 INTERPRETER 197 236 717.217383 $35860.8700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3470 4720 26223.519447 $262235.0600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 213 230 1496.090468 $107658.6900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 13.509921 $972.1700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 8 9 85.214285 $4908.3500 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 4.928571 $283.8900 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 9.371429 $674.3700 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 4.714286 $339.2400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 158 174 1048.616266 $75458.4400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 3.714286 $267.2800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 5 5 32.571429 $1874.8100 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 3 3 29.999999 $2158.8000 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.066667 $76.7600 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 5.142857 $296.0300 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.955556 $219.4200 $229.6200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 1.361112 $625.0900 $459.2500
SENS -V5264 EARMOLD 6 7 5.116667 $92.7700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 395 431 2855.547636 $205485.1200 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 11 56.476192 $4064.0300 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.285714 $16.4600 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 8 8 60.590477 $4360.0900 $71.9600
TRAV -TRAVS Travel by mile 1415 2112 125866.872203 $56010.7600 $0.4500
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Subtotal (Total Children Is Unduplicated) 7591 18899 186749.999545 $2362313.7000 $12.6500
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Total 20566 193862.022352 $2578235.3500 $13.3000
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Number of Children (Unduplicated) With at Least One Authorization 8129