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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 39099 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 422 431 1968.938875 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 42.142857 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 66 66 8242.699997 $306628.4300 $37.2000
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Subtotal (Total Children Is Unduplicated) 490 499 10253.781729 $306628.4300 $29.9000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 2.000000 $206.7200 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 155 179 140.027843 $6791.3700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 60 61 88.272127 $4952.0800 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 22 22 25.022222 $396.3500 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 45 48 52.078571 $1016.0500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 13 15 14.373015 $340.2100 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 32 34 32.817460 $481.7600 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 77 80 56.875760 $1255.2600 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 32 34 29.317461 $258.2900 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 3 2.100000 $21.9500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 46 48 41.289683 $1194.1000 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 8 10.189682 $459.3500 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 55 58 111.811905 $1544.1200 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 46 48 51.439682 $1082.2900 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 8 8 3.411111 $296.5600 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 479 498 505.403175 $37970.9400 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 39 39 33.750989 $1529.6000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 19 19 20.177582 $2336.7700 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 38 53 80.936149 $4046.8100 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 6 6 11.000000 $550.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 151 161 143.493773 $7174.7000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 28 38 77.504109 $5812.8100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 40 40 69.555555 $5216.6600 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 13 14 26.005479 $1950.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 16.500000 $1237.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 6 6 11.500000 $862.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 18 18 35.000000 $2625.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 7 7 12.005479 $900.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 10 11 22.000000 $1650.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 48 48 78.944444 $4381.4100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 9 10 16.022222 $889.2300 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 579 591 1140.352180 $85526.4400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 202 206 403.285714 $30246.4300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 175 177 344.066667 $25805.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 118 120 234.000000 $17550.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 203 203 396.285714 $29721.4300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 119 120 237.500000 $17812.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 776 801 1548.356941 $85933.8200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 292 300 586.428571 $32546.7900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 381 482 942.071428 $70655.3600 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 132 160 314.642857 $23598.2200 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 1 0.211111 $11.4400 $54.1700
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 32 32 43.700002 $6215.4800 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 8 8 22.190476 $1109.5200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 14 53.966668 $2698.3300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 120 137 57.427778 $2952.3600 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 2 2 0.455556 $23.4200 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 267 288 238.538504 $12263.2400 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 1.227778 $63.1200 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 9 9 2.205556 $113.3900 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 59 60 39.877169 $2050.0900 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 7 7 17.595695 $904.5900 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 3 3 1.511111 $77.6900 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 0.241552 $12.4200 $51.4000
OCTH -97167 OT EVAL HIGH COMPLEXITY 142 145 102.778756 $5283.8400 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 8 8 7.600000 $390.7200 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 45 51 12.895237 $662.9400 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.8200 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 79 81 32.694642 $1680.8400 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 4 4 0.722223 $37.1300 $51.4200
PSTH -97161 PT EVAL LOW COMPLEXITY 107 112 90.399624 $4647.4600 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 4 4 2.390944 $122.9200 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 0.661111 $33.9900 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 32 35 17.300306 $889.4200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 5 5 3.191781 $164.0900 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 3 3 1.505556 $77.4000 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 106 115 67.178789 $3453.6700 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 6 6 1.649163 $84.7800 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 36 39 27.112674 $1393.8400 $51.4100
SCREEN-T1023 SCREENING 74 77 78.233333 $3911.6700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 1.598022 $24.1500 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 392 423 346.550725 $17816.1500 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 5 5 3.422222 $175.9400 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 40 43 14.619045 $751.5500 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 3 3 0.588889 $30.2800 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 18 18 11.522222 $592.3600 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 6 8 2.061110 $105.9600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 299 318 153.310516 $7881.7000 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 12 12 8.334019 $428.4600 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 10 12 3.688888 $189.6400 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 3.450000 $177.3600 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 16 16 11.024505 $566.7700 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 0.728767 $37.4700 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 20 21 207.509524 $10668.0600 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 22.428572 $1153.0500 $51.4100
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Subtotal (Total Children Is Unduplicated) 4266 6935 9696.115671 $611522.5200 $63.0700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 143 155 185.522276 $927612.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 25 25 19.741630 $4572.5700 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1332 1670 1546.483274 $77324.3000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 144 160 94.650448 $4732.5500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 340 402 334.977928 $8374.4600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1840 2042 2975.404771 $148770.2800 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 86 89 111.733336 $5586.6800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 111 120 125.066664 $3126.6600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1460 1622 1913.880955 $95694.1000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 70 75 95.792065 $4789.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 57 94 92.932801 $2323.3200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 678 757 962.714676 $48135.7100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 42 45 49.410317 $2470.5200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 29 53 47.022218 $1175.5500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1961 2069 2294.284536 $114714.3000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 80 84 80.824603 $4041.2300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 124 129 141.692856 $3542.3200 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 26 28 497.566664 $12439.1700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 224 310 2045.261916 $51131.5600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 364 382 2575.512706 $128775.6200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6678 7346 43615.386195 $2180768.3400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 773 831 5223.870646 $261193.4800 $50.0000
INTR -T1013 INTERPRETER 240 304 633.912100 $31695.6000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3662 5064 24977.826938 $299733.8200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1118 1304 7021.584948 $505272.8200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 21 21 79.395240 $5713.2700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 107 116 962.992066 $55468.3300 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 9 11 74.035715 $4264.4600 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 127 142 748.984127 $53896.8200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 5 5 20.511904 $1476.0400 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 10.857143 $625.3700 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 2.000000 $115.2000 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 1051 1232 5993.912317 $431321.6700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 23 23 128.407144 $9240.1800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 64 70 417.604767 $24037.3200 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 4 12.964286 $746.2300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 113 124 683.412704 $49178.3000 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 9 10 34.865873 $2508.9400 $71.9600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 10.000000 $575.6000 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 6 3.007078 $345.2500 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 1.555251 $357.0900 $229.6000
SENS -V5060 BEHIND EAR HEARING AID 7 7 6.466667 $1484.8200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 10 10 10.094444 $4635.5500 $459.2200
SENS -V5264 EARMOLD 43 43 43.428768 $787.3600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1856 2153 11974.871080 $861711.1800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 60 68 293.611107 $21128.2600 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 7 60.750000 $3499.2100 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 8.285714 $477.2600 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 152 176 870.241272 $62622.5100 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 9 9 55.976192 $4028.0300 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 7 7 51.042857 $712.5600 $13.9600
TRAV -TRAVS Travel by mile 1522 2248 116718.180637 $51939.5900 $0.4500
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Subtotal (Total Children Is Unduplicated) 10760 31665 236942.511820 $6581031.6300 $27.7700
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Total 39099 256892.409220 $7499182.5700 $29.1900
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Number of Children (Unduplicated) With at Least One Authorization 12876