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 51859 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 1045 1208 11085.322214 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 48.885714 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 18 22 5481.022222 $203894.0300 $37.2000
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Subtotal (Total Children Is Unduplicated) 1065 1232 16615.230150 $203894.0300 $12.2700
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 327 475 550.826434 $26715.1000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 13 12.040716 $675.4800 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 14.450000 $228.8900 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 25 28 27.650000 $539.4500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 1.061111 $25.1200 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 6 5.061111 $74.3000 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 8 5.961110 $131.5600 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 7 5.555555 $48.9400 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 7 5.555555 $160.6700 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 1.061111 $47.8300 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 5 5.699999 $78.7200 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 9 9.489682 $199.6600 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 1.450000 $126.0600 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 67 75 75.000000 $5634.7500 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 4 5.411111 $245.2300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 3 1.366667 $158.2800 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 86 115 175.752968 $8787.6500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 19 23 34.118873 $1705.9500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 245 253 305.953168 $15297.6700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 5 9.000000 $675.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 13 24.500000 $1837.5000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 9.000000 $675.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 6 12.000000 $900.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 12.000000 $666.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 74 74 144.291193 $10821.8400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 18 19 38.000000 $2850.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 18 18 36.000000 $2700.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 7 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 51 51 99.785714 $7483.9300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 29 29 57.000000 $4275.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 90 90 177.005479 $9823.8100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 25 26 52.000000 $2886.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 52 61 119.000000 $8925.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 22 25 50.000000 $3750.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 1 2 2.411111 $342.9300 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 6 20.266667 $1013.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 9 86.552381 $4327.6300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 14 18 11.200002 $575.8000 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 61 72 69.061111 $3550.4300 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.900000 $46.2700 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 23.285714 $1197.1200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 31 34 28.561112 $1468.3300 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 2.027778 $104.2500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 4 5 2.883334 $148.2400 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 9 5.216668 $268.2000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 12 13 12.027779 $618.3500 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.705556 $36.2700 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 3 2.850000 $146.5200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 14 12.891269 $662.7400 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 7 7 2.655556 $136.5200 $51.4100
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 80 97 89.511906 $4601.8200 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 2 2.000000 $102.8200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 4 5 3.677779 $189.0800 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.761111 $39.1300 $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 1.000000 $51.4100 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.005556 $51.7000 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 29 35 20.277779 $1042.4900 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 6 5.838889 $300.1800 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $102.8200 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 11.757143 $604.4300 $51.4100
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Subtotal (Total Children Is Unduplicated) 1216 1848 2557.373758 $144744.7200 $56.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 63 71 103.918993 $519594.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 7 36.406567 $1820.3300 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 7.044444 $1631.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2782 4160 4289.059329 $214453.5400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 228 299 226.556680 $11327.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 597 702 638.089150 $15952.2600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3624 5438 20876.034177 $1043801.8900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 193 268 923.297622 $46164.8800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 236 321 994.172584 $24854.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3112 4541 12532.182242 $626609.0500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 144 193 581.942058 $29097.0700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 133 287 719.429768 $17985.7600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1304 2044 6795.710112 $339785.6000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 84 129 328.431310 $16421.5600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 55 137 419.016672 $10475.4300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3942 5460 15057.515436 $752875.7600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 180 231 695.191271 $34759.5700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 229 304 991.032943 $24775.8400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 6 7 143.214285 $3580.3600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 15 16 113.428570 $2835.7100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 252 315 4673.913487 $233695.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 594 801 10698.318649 $534915.9600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 65 81 1334.214288 $66710.7100 $50.0000
INTR -T1013 INTERPRETER 618 901 3975.092504 $198754.6000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7345 14533 181126.577529 $2173519.2000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 218 271 4185.234518 $301169.5500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 11.857143 $853.2400 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 26 33 566.642854 $32638.6200 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 52.285714 $3011.6600 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 26.104762 $1878.4900 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 50.714286 $3649.4000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 200 259 3814.531945 $274493.7400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 5 80.142856 $5767.0800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 9 14 233.857143 $13460.8200 $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 8 8 66.801587 $4807.0400 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 25.714286 $1850.4000 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 4 5.411111 $2484.8900 $459.2200
SENS -V5264 EARMOLD 3 6 7.822222 $141.8200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 303 407 5729.164280 $412270.7000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 6 113.723810 $8183.5700 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.857143 $164.5700 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 6 8 92.657143 $6667.6100 $71.9600
TRAV -TRAVS Travel by mile 2896 6498 890586.632724 $396311.0600 $0.4500
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Subtotal (Total Children Is Unduplicated) 13688 48779 1173938.481911 $8416579.5000 $7.1700
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Total 51859 1193111.085819 $8765218.2400 $7.3500
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Number of Children (Unduplicated) With at Least One Authorization 14605