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: 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 38516 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 413 419 3121.253961 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.533333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 87 87 10758.991266 $400234.4600 $37.2000
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Subtotal (Total Children Is Unduplicated) 501 507 13880.778560 $400234.4600 $28.8300
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 2 5.000000 $516.8000 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 182 204 177.347389 $8601.3300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 63 65 69.361437 $3891.1700 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 42 42 35.460046 $561.6900 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 124 127 128.608727 $2509.1500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 16 18 26.983333 $638.6900 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 108 111 111.854012 $1642.0200 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 72 74 58.823812 $1298.2500 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 103 106 109.258730 $962.5700 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.4500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 115 118 119.080953 $3443.8200 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 8 14.492064 $653.3000 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 64 66 48.042064 $663.4600 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 129 133 145.622222 $3063.9000 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 6 6 3.766666 $327.4700 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 362 370 369.444444 $27756.3600 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 47 48 40.445736 $1832.9900 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 12 8.123896 $940.8200 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 1.428571 $178.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 33 48 72.293379 $3614.6800 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 8 8 10.093150 $504.6600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 141 151 122.350916 $6117.5600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 28 38 88.441649 $6633.1200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 41 41 71.555555 $5366.6600 $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 8 8 14.005479 $1050.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 12 23.000000 $1725.0000 $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 80.722222 $4480.0800 $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 2 2 2.285714 $126.8600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 578 590 1138.352180 $85376.4400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 202 206 402.285714 $30171.4300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 174 176 342.066667 $25655.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 119 121 236.000000 $17700.0000 $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 120 121 238.500000 $17887.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 777 803 1552.356941 $86155.8200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 289 297 580.428571 $32213.7900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 378 477 932.071428 $69905.3600 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 131 159 312.642857 $23448.2200 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 2 2 1.173015 $63.5400 $54.1700
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 25 25 23.644443 $3362.9300 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 5 9.966667 $498.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 12 57.495237 $2874.7700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 112 120 53.300081 $2740.1800 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 244 268 228.787985 $11761.9900 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 0.683333 $35.1300 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.105556 $5.4300 $51.4300
OCTH -97166 OT EVAL MODERATE COMPLEXITY 41 41 26.571495 $1366.0500 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 13.650881 $701.7900 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 1.142466 $58.7400 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 0.491096 $25.2500 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 119 123 94.194847 $4842.5600 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 9 12 11.272222 $579.5000 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 42 48 12.606344 $648.0700 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.166667 $8.5700 $51.4200
PSTF -97164 PT RE-EVAL EST PLAN CARE 65 68 33.220552 $1707.8900 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.433333 $22.2800 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 93 101 72.823997 $3743.9000 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 1.166667 $59.9800 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.211111 $10.8500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 31 31 24.036281 $1235.7100 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 1.068493 $54.9300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.433333 $22.2800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 104 114 79.302150 $4076.9100 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 5 5 8.000000 $411.2800 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 41 45 22.942858 $1179.5000 $51.4100
SCREEN-T1023 SCREENING 58 58 59.066666 $2953.3300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.772603 $11.6700 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 310 339 279.126430 $14349.9100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 5 6 5.394444 $277.3300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 37 39 9.923014 $510.1400 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.333333 $17.1400 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 11 11 11.761111 $604.6400 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 3 3 3.106849 $159.7200 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 4 6 2.920243 $150.1300 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 301 318 167.395048 $8605.8100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 12 12 10.843542 $557.4700 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 5.261111 $270.4700 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 18 18 10.916895 $561.2400 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 5 0.381659 $19.6200 $51.4000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 35 36 252.899999 $13001.6000 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 5 5 16.000000 $822.5500 $51.4100
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Subtotal (Total Children Is Unduplicated) 3999 6989 9818.103996 $600445.6600 $61.1600
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 3 3.177778 $134.7700 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 148 163 207.891980 $1039460.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 1.394444 $96.7000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 30 31 29.905554 $6926.6900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1339 1653 1555.648264 $77782.5600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 149 166 110.132902 $5506.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 343 403 308.887055 $7722.1900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1847 2015 3287.612703 $164380.6600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 77 79 95.050003 $4752.5200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 93 94 114.961113 $2874.0300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1567 1740 2035.547617 $101777.3900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 77 82 106.982539 $5349.1300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 61 102 106.707545 $2667.7000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 654 733 993.636511 $49681.8400 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 41 41 46.670633 $2333.5200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 34 54 73.346032 $1833.6500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1933 2026 2441.057925 $122052.8700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 72 74 85.857937 $4292.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 98 100 158.344845 $3958.6300 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 17 18 161.928571 $4048.2100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 208 288 1127.592033 $28189.7900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 186 192 1103.209515 $55160.5600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6670 7335 46614.649865 $2330733.8500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 865 920 6250.835662 $312542.0900 $50.0000
INTR -T1013 INTERPRETER 228 296 679.085910 $33954.3000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3626 4934 25618.458712 $307421.7000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1104 1229 7168.343618 $515834.4500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 27 30 102.940870 $7407.6100 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 108 112 950.663486 $54758.2300 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 11 17 94.499999 $5443.2100 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 117 127 698.890472 $50292.1900 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.428571 $30.8400 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 5.000000 $288.0000 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 11.000000 $633.6000 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 969 1102 5668.912877 $407935.2800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 23 24 135.138094 $9724.5200 $71.9600
PHY -97110HM PT SESSION BY PT ASST 64 68 482.076187 $27748.3200 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 4 25.035714 $1441.0600 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 118 127 624.930157 $44970.0500 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 6 6 20.961904 $1508.4200 $71.9600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 10.000000 $575.6000 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 7 7 3.505936 $402.5100 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 3.910045 $897.7800 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 6 6 7.000000 $1607.2700 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 8 6.600000 $3030.8500 $459.2200
SENS -V5264 EARMOLD 38 39 33.527853 $607.8600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1758 1985 11831.554306 $851399.2900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 50 56 321.180952 $23112.1900 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 8 33.321428 $1919.3200 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 2 17.571428 $1012.1100 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 147 160 769.779363 $55393.3600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 20.233333 $1456.0000 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 5 5 37.000000 $516.5200 $13.9600
TRAV -TRAVS Travel by mile 1494 2341 138800.633946 $61766.2800 $0.4500
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Subtotal (Total Children Is Unduplicated) 10786 31020 261203.214187 $6807347.6200 $26.0600
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Total 38516 284902.096743 $7808027.7400 $27.4100
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Number of Children (Unduplicated) With at Least One Authorization 12024