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 17641 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 316 317 1813.323020 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 7 7 574.705556 $21379.0500 $37.2000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 322 324 2388.028576 $21379.0500 $8.9500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 136 150 138.391019 $6711.9700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 11 8.922222 $500.5400 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 6 6 15.471429 $245.0700 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 20 21 21.000000 $409.7100 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.427778 $10.1300 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 13 14 13.194445 $193.7000 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 14 14 9.377779 $206.9700 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 12 13 13.027778 $114.7700 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 12 13 13.027778 $376.7600 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.427778 $64.3700 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 17 17 9.738887 $134.4900 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 17 18 18.027778 $379.3000 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.261111 $22.7000 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 12 9.781507 $443.3000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.559285 $180.5800 $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 97 100 73.645436 $3682.2600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 6 12.500000 $937.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 3.500000 $262.5000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 0.005556 $0.4200 $75.5900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 12.000000 $666.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $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 75 76 142.521916 $10689.1500 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 23 23 42.500000 $3187.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 18 18 35.500000 $2662.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 10 10 19.000000 $1425.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 41 41 81.000000 $6075.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 12 12 23.500000 $1762.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 109 115 219.521916 $12183.4700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 56 58 115.000000 $6382.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 29 39 75.500000 $5662.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 10 11 22.000000 $1650.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 8 9 24.395239 $1219.7700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 10 53.180953 $2659.0600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 26 26 10.368722 $533.0600 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 51 54 4.804969 $247.0300 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.327778 $16.8500 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 10 10 16.961558 $872.0000 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.038356 $1.9700 $51.4700
OCTH -97167 OT EVAL HIGH COMPLEXITY 27 27 14.651598 $753.2300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 4 5 1.638889 $84.2600 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 21 21 9.558980 $491.4200 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.022222 $1.1400 $51.3600
PSTH -97161 PT EVAL LOW COMPLEXITY 12 12 7.805556 $401.2900 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.133333 $6.8500 $51.4000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 3.377169 $173.6200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 16 16 9.722222 $499.8200 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 4 4 1.122223 $57.7000 $51.4100
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 89 99 91.042597 $4680.5000 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 6.857143 $352.5200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 3 3 1.083333 $55.6900 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.246575 $12.6800 $51.4200
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.054795 $2.8200 $51.4200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 49 53 31.444445 $1616.5600 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.466667 $75.4000 $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 1 1 0.038356 $1.9700 $51.4700
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 5 5 20.219048 $1039.4600 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 827 1215 1511.249680 $86270.6500 $57.0900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 0.961112 $40.7600 $42.4100
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.011111 $42.8800 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 46 49 132.579135 $662894.5000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 2.222222 $514.7100 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1212 1469 1366.378703 $68319.1000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 154 171 150.301982 $7515.0900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 195 200 132.136334 $3303.4000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1673 1840 3122.765761 $156138.2900 $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 1211 1341 1909.495634 $95474.7900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 64 66 101.120634 $5056.0400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 43 70 90.965076 $2274.1200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 561 620 922.995554 $46149.7200 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 38 38 45.878574 $2293.9400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 13 22 28.833333 $720.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1760 1855 2277.477770 $113873.8400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 66 67 92.445237 $4622.2500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 128 137 134.422218 $3360.5500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 43.428571 $1085.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 2.255556 $56.3900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 31 33 324.371433 $16218.5600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 3 -22.250793 $-1112.5400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1576 1780 11716.088986 $585804.0500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 93 100 578.288895 $28914.4200 $50.0000
INTR -T1013 INTERPRETER 215 318 684.979416 $34248.9900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2360 3045 19611.514394 $235338.0200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 193 203 1353.196838 $97376.0300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 38.466667 $2768.0600 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 23 23 213.971431 $12324.7500 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 3 3 24.571428 $1415.3200 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 11 12 63.431748 $4564.5400 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 4.142857 $238.6300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 154 159 989.986515 $71239.3800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 34.714286 $2498.0400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 12 13 77.626192 $4468.1600 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 1.857143 $106.8900 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 7 7 45.104761 $3245.7400 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.544444 $354.6100 $229.6000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 3.427778 $1574.1100 $459.2200
SENS -V5264 EARMOLD 4 4 4.205555 $76.2500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 359 388 2595.542081 $186775.1300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 52.714285 $3793.3200 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 5 28.285716 $1629.2500 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 6 6 37.785715 $2719.0600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.600000 $331.0200 $71.9600
TRAV -TRAVS Travel by mile 1257 1834 90260.840216 $40166.0800 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6502 16102 139533.992029 $2520215.7300 $18.0600
-------------------------------------------------------------------------------------------------------------------------------------
Total 17641 143433.270285 $2627865.4300 $18.3200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 7032