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 21238 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 390 396 3077.869836 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.533333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 19 19 3453.755556 $128479.7100 $37.2000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 410 416 6532.158725 $128479.7100 $19.6700
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 3.000000 $310.0800 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 166 183 148.311023 $7193.0800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 9 8.759056 $491.3800 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 2.355556 $37.3100 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 15 15 15.455555 $301.5400 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 3.216667 $76.1400 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 16 16 14.877778 $218.4100 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 9 5.194444 $114.6400 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 16 16 16.688889 $147.0300 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 14 14 15.077778 $436.0500 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.777778 $125.2200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 16 16 9.905556 $136.8000 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 19 19 20.506349 $431.4500 $21.0400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 30 31 31.000000 $2329.0300 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 2.812404 $127.4500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.517960 $59.9800 $115.8000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 1.428571 $178.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 31 45 68.293379 $3414.6800 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 5 5 6.087671 $304.3900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 127 135 108.350916 $5417.5600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 8 23.482192 $1761.1700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 16.011111 $1200.8300 $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 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $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 2 3 6.000000 $450.0000 $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 10 10 18.000000 $999.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 2 0.022222 $1.2300 $55.4400
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 74 74 140.516437 $10538.7400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 37 37 72.500000 $5437.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 22 23 44.000000 $3300.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 26 26 51.500000 $3862.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 40 40 74.500000 $5587.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 31 31 60.000000 $4500.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 148 150 283.016437 $15707.4200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 50 51 99.500000 $5522.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 22 25 48.000000 $3600.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 12 16 31.000000 $2325.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 5 9.966667 $498.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 23.723810 $1186.2000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 14 15 4.994444 $256.7600 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 63 69 60.383333 $3104.3100 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.288889 $14.8500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 9 4.247717 $218.3700 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 20 20 11.661114 $599.5100 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 2.027778 $104.2500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 9 9 3.005555 $154.5100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 12 7.388890 $379.8700 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 16 19 14.755556 $758.5900 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.166667 $8.5700 $51.4200
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 3.772223 $193.9300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 23 25 16.496825 $848.1000 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 12 13 3.605556 $185.3600 $51.4100
SCREEN-T1023 SCREENING 3 3 3.000000 $150.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 65 69 63.289684 $3253.7300 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 3 3.000000 $154.2300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 10 10 2.511111 $129.1000 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.8200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 49 52 26.638890 $1369.5100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.8200 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $154.2300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 5.714286 $293.7700 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.000000 $51.4100 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 960 1401 1746.504724 $102005.1600 $58.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 55 57 71.919267 $359596.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1243 1521 1414.777139 $70739.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 149 166 110.132902 $5506.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 226 240 152.795801 $3819.9100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1790 1954 3245.329371 $162266.5000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 77 79 95.050003 $4752.5200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 90 91 113.194447 $2829.8700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1533 1705 2011.503172 $100575.1600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 77 82 106.982539 $5349.1300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 60 101 105.674212 $2641.8700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 628 707 972.269846 $48613.5100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 41 41 46.670633 $2333.5200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 31 51 70.690476 $1767.2600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1895 1986 2412.496813 $120624.8100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 72 74 85.857937 $4292.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 93 95 154.278179 $3856.9600 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 3.071429 $76.7900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 39 43 123.299993 $3082.4900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 103 108 643.685706 $32184.3300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1552 1705 10814.419019 $540721.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 197 202 1448.957134 $72447.9500 $50.0000
INTR -T1013 INTERPRETER 205 267 617.014482 $30850.7300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3623 4929 25601.030141 $307212.5600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 201 214 1228.203962 $88381.6000 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 13.390476 $963.5700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 13 13 112.187300 $6461.9800 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 3 4 11.214286 $645.9400 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 11 11 42.290474 $3043.2300 $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
PHY -97110 PT SESSION BY LICENSED PT 150 163 742.993849 $53465.8800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 7 8 58.571429 $3371.3700 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 6.535714 $376.1900 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 17 18 89.873016 $6467.2800 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.333333 $95.9400 $71.9600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 10.000000 $575.6000 $57.5600
SENS -V5060 BEHIND EAR HEARING AID 1 1 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 1.411111 $648.0100 $459.2200
SENS -V5264 EARMOLD 3 3 1.111111 $20.1400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 364 402 2470.349989 $177766.5000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 12 37.923809 $2729.0000 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.142857 $469.0300 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 13 15 67.833334 $4881.3000 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.714286 $483.1600 $71.9600
TRAV -TRAVS Travel by mile 1490 2336 138788.919660 $61761.0700 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 7714 19421 194129.529208 $2299827.9200 $11.8500
-------------------------------------------------------------------------------------------------------------------------------------
Total 21238 202408.192657 $2530312.7900 $12.5000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 8361