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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 38625 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 0.008333 $0.3100 $37.0600
SCONLY-SCONLY *SERVICE COORDINATION ONLY 427 441 2445.514283 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 70 72 12519.752378 $465734.7800 $37.2000
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Subtotal (Total Children Is Unduplicated) 497 514 14965.274994 $465735.0900 $31.1200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 167 202 163.154149 $7913.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 66 66 71.693769 $4022.0200 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 4 4 2.488889 $39.4200 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 130 134 145.353175 $2835.8400 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 27 27 25.277778 $598.3300 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 24 24 24.115764 $354.0200 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 87 87 56.757141 $1252.6200 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 26 26 24.859523 $178.9900 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 7 7 7.000000 $73.1500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 41 41 37.365078 $1080.6000 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 12 12 11.166667 $503.3900 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 66 66 59.805555 $825.9100 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 30 31 30.835322 $648.7800 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 2 2 1.361111 $83.0300 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 3 3 2.261111 $196.5800 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 468 506 559.593347 $42042.2400 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 43 43 36.565601 $1657.1500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 7.106545 $823.0200 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 26 30 56.838639 $2841.9400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 4 1.574276 $78.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 100 103 116.004251 $5800.2300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 20 27 48.577778 $3643.3400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 27 28 52.505479 $3937.9100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 16 16 28.500000 $2137.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 16.000000 $1200.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 9 9 16.011111 $1200.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 19 19 37.500000 $2812.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 6 6 10.000000 $750.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 18 22 41.505479 $3112.9100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 46 46 85.000000 $4717.5000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 17 18 29.659056 $1646.0700 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.000000 $55.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 535 537 1061.072146 $79580.4200 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 215 216 420.016437 $31501.2400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 157 159 311.285714 $23346.4300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 103 104 202.005479 $15150.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 195 196 381.000000 $28575.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 99 101 196.500000 $14737.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 773 789 1551.000717 $86080.5400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 319 328 630.688583 $35003.2200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 403 516 996.320482 $74724.0500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 151 176 346.500000 $25987.5000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 20 21 16.411113 $2334.1800 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.633333 $31.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 15 80.852381 $4042.6300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 124 130 55.036506 $2829.4200 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 1.316667 $67.6900 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 274 309 313.323959 $16107.9700 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.153425 $7.8900 $51.4000
OCTH -97165TL OT EVAL LOW COMPLEXITY 9 9 2.255555 $115.9600 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 49 51 35.559210 $1828.1000 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 6 6 4.543303 $233.5700 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 4 4 2.394444 $123.1000 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 1.082192 $55.6400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 176 177 122.243346 $6284.5300 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 5 5 3.633333 $186.7900 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 34 39 14.227777 $731.4500 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 74 78 33.733333 $1734.2300 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 0.738889 $37.9900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 104 116 81.616207 $4195.8700 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 1.400000 $71.9700 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 6 6 2.605555 $133.9500 $51.4100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 0.126027 $6.4800 $51.4000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 28 30 15.357522 $789.5200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 6 6 2.539727 $130.5700 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 1.250000 $64.2600 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 116 120 66.464948 $3416.9700 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 5 5 1.750533 $89.9900 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 25 28 17.949209 $922.7800 $51.4100
SCREEN-T1023 SCREENING 52 53 57.133333 $2856.6700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 4 3.153424 $47.6500 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 429 481 384.729796 $19778.9900 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 2.188889 $112.5300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 29 32 7.922220 $407.2700 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 0.794445 $40.8500 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 20 20 15.605327 $802.2700 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 4 2.416666 $124.2400 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 6 6 3.016667 $155.0900 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 352 378 185.631275 $9543.3400 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 7 9 5.948411 $305.8000 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 3.205555 $164.7900 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.394444 $174.5100 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.8200 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 28 28 20.266668 $909.1700 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.272222 $12.2100 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 19 21 163.285714 $8642.7000 $52.9300
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Subtotal (Total Children Is Unduplicated) 4276 6985 9654.989702 $605259.5900 $62.6900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 139 145 179.865361 $899327.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 14 14 9.491782 $474.6000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 6 6 15.789682 $1095.0200 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 2.022222 $140.2400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 28 28 51.007600 $11814.4000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1405 1762 1527.511670 $76375.8500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 96 118 84.295217 $4214.7400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 416 497 516.103204 $12902.5900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1750 1953 2890.566301 $144528.3800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 92 94 110.783330 $5539.1600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 108 116 131.104766 $3277.6300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1400 1559 1764.706000 $88235.2900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 54 60 79.387302 $3969.3700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 47 77 62.722215 $1568.0400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 673 755 1016.487993 $50824.4800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 56 66 65.255557 $3262.7900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 24 37 41.976193 $1049.4100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1961 2099 2332.069808 $116603.5000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 91 93 112.026984 $5601.3500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 114 121 140.833340 $3520.8500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 28 28 460.142861 $11503.5600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 190 217 1594.823811 $39870.6300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 432 480 3285.473821 $164273.6900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6402 7030 42805.087477 $2140254.8600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 674 722 4400.988895 $220049.5500 $50.0000
INTR -T1013 INTERPRETER 276 360 799.857143 $39992.8700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3515 4799 24247.999164 $242480.0600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1164 1372 7731.369050 $556349.3100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 30 31 183.441271 $13200.4400 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 126 135 1006.377778 $57967.3600 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 5 5 14.107142 $812.5700 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 100 114 510.522612 $36737.2700 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 8 9 34.190476 $2460.3400 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 3.200000 $184.3200 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 34.285714 $1974.8600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 1016 1177 6167.059717 $443781.7200 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 25 25 130.564285 $9395.4300 $71.9600
PHY -97110HM PT SESSION BY PT ASST 69 76 450.966667 $25957.6400 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 4 22.535714 $1297.1500 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 81 94 442.240479 $31823.6300 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 10 10 55.733333 $4010.5800 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 1.785714 $102.7800 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 5.714286 $328.9200 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 6 2.458904 $282.3100 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 3.796195 $871.6500 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 5 5 2.998478 $688.4900 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 13 13 18.944444 $8699.6500 $459.2200
SENS -V5264 EARMOLD 45 46 55.697488 $1009.7900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2009 2355 13944.888087 $1003474.2900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 72 80 416.847616 $29996.3800 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 10.571428 $608.9100 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 4.000000 $230.4000 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 110 128 596.528568 $42926.2300 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 15 17 89.666666 $6452.4200 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 3 3 6.071429 $84.7600 $13.9600
TRAV -TRAVS Travel by mile 1474 2168 114141.915589 $50793.1500 $0.4500
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Subtotal (Total Children Is Unduplicated) 10621 31126 234816.858829 $6625252.5900 $28.2100
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Total 38625 259437.123525 $7696247.2600 $29.6700
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Number of Children (Unduplicated) With at Least One Authorization 12619