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 21298 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 401 415 1956.981745 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 29 30 3177.141267 $118189.6500 $37.2000
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Subtotal (Total Children Is Unduplicated) 431 446 5134.131345 $118189.9500 $23.0200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 140 172 137.761541 $6681.4600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 17 17 15.618700 $876.2100 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 19 20 29.442064 $574.4200 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 2.361111 $55.8900 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.927778 $28.3000 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 4.077778 $90.0000 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 0.972222 $7.0000 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 0.994444 $28.7600 $28.9200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 6 6 4.866666 $67.2100 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 5 3.077778 $64.7600 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.361111 $22.0300 $61.0000
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 67 69 89.428571 $6718.7700 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 9 6.674353 $302.4800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 3.046575 $352.8300 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 23 25 37.952131 $1897.6100 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 4 1.574276 $78.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 86 88 106.932823 $5346.6500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 4.577778 $343.3400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 18.500000 $1387.5000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 2.500000 $187.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $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 8 8 15.500000 $1162.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 12 21.500000 $1193.2500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 5.500000 $305.2500 $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 72 72 142.000000 $10650.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 53 53 102.505479 $7687.9100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 28 28 54.500000 $4087.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 26 26 49.005479 $3675.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 42 42 81.500000 $6112.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 30 31 60.500000 $4537.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 160 163 319.000000 $17704.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 76 76 147.110958 $8164.6600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 38 45 89.000000 $6675.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 18 20 39.500000 $2962.5000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 1 2 0.666667 $94.8200 $142.2400
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.633333 $31.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 12.971429 $648.5700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 23 23 8.755557 $450.1300 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 66 78 101.052382 $5195.1000 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.138889 $7.1400 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 5.338889 $274.4700 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.333333 $17.1400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 25 25 16.543759 $850.5100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.166667 $8.5700 $51.4200
PSTF -97164 PT RE-EVAL EST PLAN CARE 16 16 3.555556 $182.7900 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.366667 $18.8500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 13 16 12.083332 $621.2000 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.400000 $20.5600 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 1.385312 $71.2200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 19 20 9.055554 $465.5400 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 6 7 0.622224 $32.0000 $51.4200
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 97 109 95.151859 $4891.7600 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 4 4 0.772222 $39.7000 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.238889 $12.2800 $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 1.266667 $65.1200 $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 45 49 36.402382 $1871.4500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.177778 $60.5500 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.155556 $51.8400 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.285714 $173.9100 $52.9300
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Subtotal (Total Children Is Unduplicated) 987 1425 1940.290233 $118084.8700 $60.8600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 42 44 65.153750 $325768.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 5 4.514155 $225.7100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 4.344445 $1006.2700 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1302 1623 1371.665960 $68583.5700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 95 117 84.292477 $4214.6100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 271 290 284.289728 $7107.2600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1726 1929 2875.760745 $143788.1000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 91 93 110.249997 $5512.5000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 108 116 131.104766 $3277.6300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1376 1534 1741.514731 $87075.7300 $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 654 736 995.099104 $49755.0300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 56 66 65.255557 $3262.7900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 23 36 41.376193 $1034.4100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1934 2071 2307.953141 $115397.6600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 91 93 112.026984 $5601.3500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 112 118 139.788895 $3494.7400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 28.428572 $710.7100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 13.857143 $346.4300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 332 365 2605.896042 $130294.8200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1404 1541 8701.565848 $435078.4100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 120 122 742.947620 $37147.3800 $50.0000
INTR -T1013 INTERPRETER 249 324 740.500000 $37025.0100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3514 4797 24235.142022 $242351.4900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 249 277 1580.489684 $113732.0500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 9.420635 $677.9100 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 20 22 150.000000 $8640.0100 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 6 6 11.226986 $807.8900 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 4 12.161904 $875.1700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 213 236 1125.486902 $80990.0500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 4 4 17.285714 $1243.8900 $71.9600
PHY -97110HM PT SESSION BY PT ASST 11 12 74.285714 $4275.8900 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 6 7 17.928572 $1290.1400 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 0.142857 $10.2800 $71.9800
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 1 1 0.377778 $43.3800 $114.8200
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.488889 $341.8700 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 2.911111 $1336.8400 $459.2200
SENS -V5264 EARMOLD 8 9 6.738889 $122.1800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 422 483 2957.436500 $212817.1800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 10 26.485713 $1905.9100 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.571429 $148.1100 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 4 4 27.428572 $1973.7600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.428571 $30.8400 $71.9600
TRAV -TRAVS Travel by mile 1474 2168 114141.915589 $50793.1500 $0.4500
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Subtotal (Total Children Is Unduplicated) 7664 19427 167719.549401 $2196155.0200 $13.0900
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Total 21298 174793.970979 $2432429.8500 $13.9200
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Number of Children (Unduplicated) With at Least One Authorization 8446