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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 104026 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 1071 1238 11430.553959 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 48.885714 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 242 268 111890.599203 $4162330.2800 $37.2000
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Subtotal (Total Children Is Unduplicated) 1312 1508 123370.038876 $4162330.2800 $33.7400
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 3 7.000000 $723.5200 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 343 497 570.817737 $27684.6800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 124 138 375.860470 $21085.7800 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 47 47 82.394443 $1305.1300 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 335 385 572.823806 $11175.7900 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 23 35 63.429365 $1501.3700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 97 117 147.412318 $2164.0100 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 179 206 260.188351 $5742.3700 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 97 114 168.290477 $1482.6400 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 6 6 10.600000 $110.7700 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 115 137 191.990478 $5552.3700 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 9 20 49.918254 $2250.3200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 113 143 346.362697 $4783.2700 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 123 142 225.715808 $4749.0600 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.872222 $53.2000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 8 9 21.991269 $1911.9200 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1018 1170 1273.455589 $95674.7100 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 79 91 90.413165 $4097.5200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 15 21 66.709067 $7725.5700 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 89 119 181.719635 $9085.9900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 19 23 34.118873 $1705.9500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 262 271 319.383326 $15969.1800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 50 67 134.159381 $10061.9500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 79 81 148.055402 $11104.1600 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 37 38 70.005479 $5250.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 14 14 28.000000 $2100.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 13 13 23.511111 $1763.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 39 39 77.000000 $5775.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 20 20 34.005479 $2550.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 33 43 80.505479 $6037.9100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 14 17 32.000000 $2400.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 102 103 178.291171 $9895.1600 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 29 29 50.159056 $2783.8200 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 3 3 5.000000 $277.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1338 1362 2625.630119 $196922.3300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 608 620 1173.321025 $87999.0800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 362 365 704.566667 $52842.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 199 203 396.505479 $29737.9100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 478 482 946.285714 $70971.4300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 304 307 562.052129 $42153.9200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1877 1935 3719.308537 $206421.6800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 791 810 1525.543377 $84667.6600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1019 1273 2478.006196 $185850.4700 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 372 451 884.214286 $66316.0700 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 2 3 3.206348 $173.6900 $54.1700
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 33 57 135.577773 $19283.1600 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 10 11 102.238096 $5111.9100 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 30 37 397.433334 $19871.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 213 312 256.454055 $13184.3500 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 2 2 1.138889 $58.5500 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 2.027778 $104.2500 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 545 692 736.895159 $37883.7700 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 1.988888 $102.2400 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 17 17 11.827779 $608.0700 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 110 123 119.045601 $6120.1700 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 12 15 57.325332 $2947.0900 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 8 8 5.170243 $265.8000 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 4 5 26.198043 $1346.8400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 364 406 433.171103 $22269.3400 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 21 24 21.455555 $1103.0300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 78 106 61.445236 $3158.8900 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 7 7 7.122223 $366.1600 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 133 203 172.479483 $8867.2200 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 5 7 4.933334 $253.6300 $51.4100
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 1 0.672222 $34.5600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 201 263 242.295455 $12456.4200 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 4 4 3.501370 $180.0100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 8 9 5.011112 $257.6300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 53 66 64.456981 $3313.7400 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 10 13 8.520549 $438.0300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 3 3 2.255556 $115.9600 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 231 290 254.196122 $13068.2400 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 13 14 14.067961 $723.2400 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 53 75 73.586800 $3783.1000 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 134 137 139.343378 $6967.1700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 4 11.671689 $176.3600 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 630 849 871.179547 $44787.3900 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 11 12 10.238888 $526.3800 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 58 91 79.523810 $4088.3300 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 4 5 3.149999 $161.9400 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 34 39 43.554414 $2239.1300 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 6 6 6.329071 $325.3700 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 10 11 8.850610 $455.0100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 616 845 637.486134 $32773.2600 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 24 31 28.103131 $1444.7900 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 21 30 21.366667 $1098.4600 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 6 8 5.569863 $286.3500 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 1.727778 $88.8300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 33 39 28.628006 $1471.7700 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 7 3.077093 $158.1900 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 28 37 530.047618 $27249.7400 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 3 4 62.571429 $3216.8000 $51.4100
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Subtotal (Total Children Is Unduplicated) 8299 16909 26659.710942 $1615663.0000 $60.6000
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 2.177778 $92.3600 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 273 345 823.602245 $4118012.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 13 13 198.951011 $9947.5500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 8 8 170.238889 $11806.0700 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 2.358904 $163.5900 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 60 65 157.799367 $36549.4300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2984 4494 4619.706876 $230985.9200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 229 300 228.556680 $11427.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 829 1077 1033.803169 $25845.1000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3687 5520 20963.450841 $1048172.7100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 193 268 923.297622 $46164.8800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 238 327 1006.994805 $25174.8800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3152 4587 12603.145734 $630157.2200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 145 194 583.275391 $29163.7400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 135 289 721.407545 $18035.2000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1336 2084 6844.987890 $342249.4900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 84 129 328.431310 $16421.5600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 56 138 425.083339 $10627.1000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3991 5523 15133.649560 $756682.4500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 180 231 695.191271 $34759.5700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 237 314 1009.010720 $25225.2800 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 59 83 3641.742855 $91043.5800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 358 811 10475.558696 $261888.9800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 382 490 7046.128567 $352306.4700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13298 21228 315443.589875 $15772181.7500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1886 2636 41787.898345 $2089395.2200 $50.0000
INTR -T1013 INTERPRETER 660 981 4201.949646 $210097.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7346 14541 181252.434672 $2175029.4900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1956 3113 43267.350332 $3113519.2000 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 53 67 867.729363 $62441.8000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 249 368 6663.927761 $383842.3000 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 14 19 230.035713 $13250.0600 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 252 370 4519.569043 $325228.2300 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 7 7 103.820634 $7470.9300 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 16.733334 $963.8400 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 2 3 136.571428 $7866.5200 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 1624 2740 37247.101752 $2680301.8500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 44 57 660.302383 $47515.3400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 114 200 3202.757134 $184350.7600 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 7 11 116.035716 $6679.0100 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 203 309 3529.607933 $253990.6500 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 14 20 337.376190 $24277.6000 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 7 9 9.842312 $1129.9900 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 4 5 4.511111 $1035.7900 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 7 8 13.108219 $3009.7700 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 13 17 19.744444 $9067.0200 $459.2200
SENS -V5264 EARMOLD 50 72 166.977776 $3027.3100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2773 4427 61808.958755 $4447773.4300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 98 135 1874.195235 $134867.1400 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 10 16 201.999999 $11635.2100 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 2 24.000000 $1382.4000 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 257 409 4518.763486 $325170.2400 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 15 19 259.128571 $18646.8900 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 13 18 169.961904 $2372.6700 $13.9600
TRAV -TRAVS Travel by mile 2896 6505 890703.632724 $396363.1200 $0.4500
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Subtotal (Total Children Is Unduplicated) 19025 85609 1692998.166855 $40846785.9300 $24.1300
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Total 104026 1843027.916673 $46624779.2100 $25.3000
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Number of Children (Unduplicated) With at Least One Authorization 20869