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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 155853 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
CASE -CASE NON-TCM CASE MANAGEMENT 2 2 0.175000 $6.5100 $37.2000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 1531 1789 16963.317447 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 48.885714 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 289 312 131030.822220 $4874346.5800 $37.2000
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Subtotal (Total Children Is Unduplicated) 1820 2105 148043.200381 $4874353.0900 $32.9300
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 544 826 893.532830 $43336.3200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 185 204 553.885476 $31072.9900 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 25 26 59.515874 $942.7300 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1051 1246 1607.846031 $31369.0700 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 180 196 225.709523 $5342.5400 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 108 124 183.754229 $2697.5100 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 344 397 427.799420 $9441.5500 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 112 127 192.176982 $1693.0800 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 33 35 39.600000 $413.8200 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 155 176 244.693650 $7076.5400 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 44 54 88.526190 $3990.7600 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 191 223 431.603965 $5960.4500 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 155 178 313.596564 $6598.0700 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 3 3 2.994444 $182.6600 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 10 13 11.000000 $956.3400 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1224 1375 1526.187955 $114662.5000 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 141 161 174.002511 $7885.8000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 54 65 107.528319 $12452.8500 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 130 175 280.556479 $14027.8300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 22 26 40.036681 $2001.8400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 410 427 492.022326 $24601.1400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 89 120 229.565219 $17217.3900 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 124 128 235.643225 $17673.2400 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 56 57 99.038659 $7427.9000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 26 26 51.000000 $3825.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 21 21 39.511111 $2963.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 61 61 120.500000 $9037.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 31 31 45.035920 $3377.6900 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 53 68 130.505479 $9787.9100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 20 24 45.000000 $3375.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 162 165 296.314188 $16445.4300 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 55 59 94.217275 $5229.0500 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 5 5 7.000000 $388.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1973 2004 3875.096326 $290632.3100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 927 944 1777.637461 $133322.8100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 564 569 1102.852381 $82713.9300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 339 343 662.520547 $49689.0500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 721 725 1411.976984 $105898.2800 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 439 445 806.590485 $60494.2800 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2787 2863 5521.316166 $306433.1100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1216 1241 2343.841091 $130083.1700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1532 1948 3793.891910 $284541.9000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 542 651 1290.000000 $96750.0100 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 2 3.233333 $175.1500 $54.1700
MED -99204 OUTPATIENT VISIT, NEW, 45 MINS 1 1 1.911111 $296.1800 $154.9800
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 51 77 280.644441 $39916.0100 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 14 15 120.390476 $6019.5300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 44 57 557.785717 $27889.2900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 377 548 452.401431 $23257.9800 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 5 5 3.166667 $162.8000 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 2 2 1.350000 $69.4000 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 3 3.027778 $155.6600 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 900 1156 1224.473611 $62950.2500 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 5 5 3.260350 $167.6100 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 28 32 22.511110 $1157.2900 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 179 209 169.862257 $8732.6400 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 20 22 52.432061 $2695.5300 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 11 11 8.038888 $413.2700 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 5 5 3.745282 $192.5500 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 704 804 812.709367 $41781.4300 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 29 32 25.711113 $1321.8200 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 89 115 70.653456 $3632.2900 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 8 9 29.834127 $1533.7800 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 222 318 290.314758 $14925.1100 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 6 8 6.561112 $337.3100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 338 437 448.071520 $23035.3800 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 8 10 8.784703 $451.6200 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 19 22 36.808729 $1892.3300 $51.4100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 0.364384 $18.7300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 110 144 132.320737 $6802.6300 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 16 17 11.017884 $566.4200 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 4 4 3.205556 $164.8000 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 1.938889 $99.6800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 441 567 449.312019 $23099.1500 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 18 19 12.114917 $622.8300 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 61 83 143.995530 $7402.8000 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 4 4 4.044444 $207.9200 $51.4100
SCREEN-T1023 SCREENING 209 226 234.254490 $11712.7300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 9 12 27.040487 $408.5800 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1193 1661 1760.359085 $90500.1600 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 21 21 17.144260 $881.3900 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 84 114 97.176187 $4995.8200 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 6 7 5.177777 $266.1900 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 69 79 76.165069 $3915.6500 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 13 13 13.772222 $708.0300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 20 26 30.994445 $1593.4300 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 3 3 2.533333 $130.2400 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1151 1601 1197.127853 $61544.5100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 30 36 53.712587 $2761.3500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 24 32 22.305556 $1146.7300 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 15 19 14.778614 $759.7700 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 24 25 20.561111 $1057.0500 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 109 148 111.820686 $5748.6800 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 7 4.784323 $245.9700 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 1.584932 $81.4800 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 70 96 1500.680950 $77150.0200 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 52.000000 $2673.3200 $51.4100
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Subtotal (Total Children Is Unduplicated) 13522 27434 42517.595601 $2534648.1700 $59.6100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 448 595 1151.042593 $5755215.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 93 107 394.889203 $19744.4500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 10 13 265.734921 $18428.7300 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 14 17 25.817439 $1790.4500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 109 136 260.310992 $60293.2300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4399 6726 6708.203958 $335411.1100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 400 531 345.669252 $17283.4600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1305 1753 1678.187632 $41954.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5231 8103 30368.667921 $1518433.6500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 300 395 1500.888891 $75044.4400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 372 527 1466.378936 $36659.4900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4236 6385 18633.569359 $931678.4900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 223 263 735.224604 $36761.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 186 392 995.859673 $24896.4800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1907 2998 10324.367433 $516218.4800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 151 211 545.517027 $27275.8500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 71 168 468.009523 $11700.2400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5958 8493 24063.190453 $1203159.5800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 315 394 1130.307939 $56515.4200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 400 541 1559.124222 $38978.1500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 80 120 5077.814285 $126945.3600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 486 1045 14651.390470 $366284.7800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1795 2370 39075.034135 $1953751.7100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 15.428571 $771.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 18045 29163 422490.958577 $21124548.3500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2031 2721 41905.140481 $2095256.9900 $50.0000
INTR -T1013 INTERPRETER 820 1194 4720.954407 $236047.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9646 19534 244313.616830 $2931763.4300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 3238 5325 70397.593612 $5065811.0700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 80 100 1209.769440 $87055.0200 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 393 610 9982.250386 $574977.6200 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 19 22 262.999999 $15148.8000 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 277 370 4787.300002 $344494.0400 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 33 36 322.734920 $23224.0000 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 3 4 28.909524 $1665.1900 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 2 2 125.571428 $7232.9200 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 2785 4932 63297.440069 $4554883.9000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 74 88 1139.759524 $82017.1200 $71.9600
PHY -97110HM PT SESSION BY PT ASST 202 345 4817.453961 $277292.6900 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 12 17 195.159525 $11233.3800 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 232 333 4121.814290 $296605.7200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 49 64 675.250001 $48591.0000 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 2 4 51.857143 $2984.8900 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 4 5 47.023810 $2706.6900 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 12 17 17.558598 $2015.9000 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 17 22 24.160579 $5547.4900 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 17 22 30.663165 $7040.5500 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 36 47 63.750000 $29275.2700 $459.2200
SENS -V5264 EARMOLD 122 182 441.423437 $8003.0000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5551 9284 124240.467913 $8940344.2100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 183 261 3288.721429 $236656.4100 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 15 17 167.699999 $9659.5300 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 3 38.571429 $2221.7100 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 303 446 5575.784125 $401233.4200 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 67 93 925.573016 $66604.2400 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 33 50 506.119047 $7065.4200 $13.9600
TRAV -TRAVS Travel by mile 3962 8717 1175415.375398 $523059.8500 $0.4500
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Subtotal (Total Children Is Unduplicated) 27412 126314 2347070.055496 $61197463.4000 $26.0700
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Total 155853 2537630.851478 $68606464.6600 $27.0400
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Number of Children (Unduplicated) With at Least One Authorization 31592