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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 33786 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 329 330 1827.267466 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 58 59 10182.244445 $378779.5000 $37.2000
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Subtotal (Total Children Is Unduplicated) 386 389 12009.511911 $378779.5000 $31.5400
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 4 4 2.488889 $257.2500 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 156 170 154.699694 $7502.9400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 54 54 50.183332 $2815.2800 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 32 33 52.571429 $832.7300 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 439 445 440.666667 $8597.4100 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 7 7 5.183334 $122.6900 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 349 352 348.966668 $5122.8300 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 77 77 53.297624 $1176.2900 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 354 357 353.061113 $3110.4700 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 349 352 349.344446 $10103.0500 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 6 6.033334 $271.9900 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 61 61 32.516663 $449.0500 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 365 368 373.702633 $7862.7000 $21.0400
AUDE -92602 REPROGRAM COCHLEAR IMPLT <7 1 1 3.333333 $202.4300 $60.7300
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 3 2.733333 $166.7300 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 3 3 1.750000 $152.1500 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 40 40 33.829376 $1533.1400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 12 10.975495 $1271.0700 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.355556 $17.7800 $50.0100
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 2 4.000000 $200.0000 $50.0000
EXIT -EXIT COS Exit 102 107 80.145436 $4007.2600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 27 34 62.000000 $4650.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 43 45 80.727702 $6054.5900 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 8.148336 $611.1300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 10 10 18.022222 $1351.6700 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 18 18 34.000000 $2550.0000 $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 13 17 32.500000 $2437.5000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 3 3 3.505556 $262.9200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 47 49 85.383257 $4738.7700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 24.505479 $1360.0600 $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 474 485 924.076706 $69305.7800 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 147 147 285.500000 $21412.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 161 162 319.500000 $23962.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 71 71 140.500000 $10537.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 190 190 374.500000 $28087.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 45 45 88.500000 $6637.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 661 682 1321.082185 $73320.0800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 281 287 567.500000 $31496.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 424 529 1045.076908 $78380.7700 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 108 134 268.000000 $20100.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 7 7 9.544444 $1357.5000 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 10 11 32.823811 $1641.2000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 17 17 81.761906 $4088.1100 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 104 110 48.381812 $2487.3100 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 2 2 -1.094444 $-56.2600 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 0.233333 $11.9900 $51.4000
OCTH -97165 OT EVAL LOW COMPLEXITY 200 219 143.665765 $7385.8600 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 7 7 7.444445 $382.7200 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 29 29 28.413385 $1460.7400 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 13.466927 $692.3400 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 0.259512 $13.3400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 105 106 81.039876 $4166.2500 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 41 42 22.022219 $1132.1500 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 57 59 27.766437 $1427.4700 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 4 4 0.456240 $23.4500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 88 90 77.200686 $3968.9000 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 3 4.966667 $255.3400 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 3 3 1.250000 $64.2600 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 23 24 11.047793 $567.9700 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 98 106 57.190490 $2940.1700 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.127778 $6.5700 $51.4200
PSTH -97163TL PT EVAL HIGH COMPLEXITY 29 29 10.938888 $562.3600 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 23 23 23.000000 $1150.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.920548 $13.9100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 336 375 325.370335 $16727.3100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 7 7 21.130953 $1086.3400 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 36 38 32.511107 $1671.3800 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 3 4 1.772222 $91.1100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 8 10 4.755327 $244.4800 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 0.186302 $9.5800 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 3 0.242845 $12.4800 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 274 296 163.392855 $8400.0100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 3.472222 $178.5100 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 2.938889 $151.0900 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 3.000000 $154.2300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 10 10 5.949695 $305.8700 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 0.161644 $8.3100 $51.4300
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 46 49 297.714290 $15305.4800 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 3 3 18.085714 $929.7900 $51.4100
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Subtotal (Total Children Is Unduplicated) 3505 7117 9641.385103 $526425.9400 $54.6000
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 10 10 5.338891 $226.4300 $42.4100
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.011111 $42.8800 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 133 146 250.906543 $1254531.0000 $4999.9900
AUD -92630 AUD REHAB PRELING HEARING LOSS 20 20 27.261907 $1890.6200 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 8.444445 $585.6300 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 14 14 12.044444 $2789.7200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1327 1623 1541.892720 $77094.8200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 154 171 150.301982 $7515.0900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 330 390 330.738416 $8268.4500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1739 1909 3177.582429 $158879.1300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 79 81 128.809524 $6440.4700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 105 111 118.500001 $2962.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1244 1375 1938.040079 $96902.0100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 64 66 101.120634 $5056.0400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 44 71 91.898409 $2297.4500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 588 647 945.256665 $47262.7800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 38 38 45.878574 $2293.9400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 23 27.816666 $695.4200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1809 1904 2324.588884 $116229.4100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 66 67 92.445237 $4622.2500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 130 139 139.155551 $3478.8800 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 18 20 644.571428 $16114.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 135 149 1100.326995 $27508.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 40 42 421.123815 $21056.1800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 6 -9.250793 $-462.5400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6416 7099 48194.132556 $2409705.3600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 383 401 2618.742884 $130937.0200 $50.0000
INTR -T1013 INTERPRETER 239 346 735.407987 $36770.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2360 3046 19612.914394 $235354.8200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 962 1055 6521.868289 $469313.4300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 22 22 139.991270 $10073.7800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 97 102 801.976194 $46193.8100 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 5 5 31.285714 $1802.0600 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 159 173 931.957950 $67063.6200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 9.400000 $676.4200 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 2 2 5.714286 $329.1400 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 867 950 5369.149233 $386363.8700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 23 24 158.904764 $11434.7800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 49 58 393.654762 $22658.7700 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 7 7 41.428572 $2384.6300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 77 80 500.055560 $35983.9800 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 13.371429 $962.2100 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 5 2.353425 $270.1900 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 4 5 5.520851 $1267.6100 $229.6000
SENS -V5060 BEHIND EAR HEARING AID 5 5 4.783333 $1098.2900 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 7 7.094445 $3257.9400 $459.2200
SENS -V5264 EARMOLD 39 39 47.728342 $865.3100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1617 1789 11263.708808 $810536.0100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 33 34 239.952383 $17266.9700 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 11 14 148.300001 $8542.0800 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 2 10.857143 $625.3700 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 117 128 753.485722 $54220.7900 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 7 7 22.090475 $1589.6300 $71.9600
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 1 1 7.571429 $436.1100 $57.6000
SPL -92508HA GROUP SPL SESSION PER CHILD 5 5 35.428571 $494.5800 $13.9600
TRAV -TRAVS Travel by mile 1257 1835 90262.240216 $40166.7000 $0.4500
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Subtotal (Total Children Is Unduplicated) 9653 26280 202506.875545 $6672926.6900 $32.9500
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Total 33786 224157.772559 $7578132.1300 $33.8100
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Number of Children (Unduplicated) With at Least One Authorization 10731