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
Eligibility Filter: Program Patients
With the filters selected there were 157183 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 1 1 0.008333 $0.3100 $37.0600
SCONLY-SCONLY *SERVICE COORDINATION ONLY 1523 1751 19905.647605 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 4 140.276190 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 312 340 130441.398411 $4852420.0100 $37.2000
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Subtotal (Total Children Is Unduplicated) 1836 2096 150487.330539 $4852420.3200 $32.2400
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 546 807 933.604482 $45279.8300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 228 264 588.212731 $32998.7400 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 81 82 134.292586 $2127.1900 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 538 603 832.181741 $16235.8600 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 57 79 131.303967 $3107.9600 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 170 200 266.006185 $3904.9700 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 276 326 379.473056 $8374.9900 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 171 199 299.591269 $2639.4000 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 12 13 17.600000 $183.9200 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 208 245 350.674605 $10141.5200 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 20 33 68.018254 $3066.2600 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 204 247 455.651588 $6292.5500 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 229 265 420.490236 $8847.1200 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 4 5 7.044443 $429.7000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 16 22 36.269046 $3153.2200 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1556 1777 1941.293509 $145849.3700 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 149 174 171.979296 $7794.0900 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 44 54 95.254727 $11031.4400 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 1.428571 $178.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 125 168 272.830452 $13641.5300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 26 30 43.129831 $2156.5000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 376 392 438.693559 $21934.7000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 84 114 226.716458 $17003.7300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 122 126 234.566513 $17592.4900 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 57 58 101.038659 $7577.9000 $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 32 32 47.035920 $3527.6900 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 54 69 131.505479 $9862.9100 $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 159 163 293.264981 $16276.2000 $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 6 6 7.285714 $404.3600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1976 2008 3890.662993 $291799.8100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 925 942 1772.873078 $132965.4800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 561 566 1096.852381 $82263.9300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 341 345 668.520547 $50139.0500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 720 724 1411.576984 $105868.2800 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 442 448 809.994595 $60749.5900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2790 2866 5529.718906 $306899.4600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1214 1239 2340.846571 $129916.9800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1532 1946 3789.891910 $284241.9000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 541 649 1275.714286 $95678.5700 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 2 3 3.206348 $173.6900 $54.1700
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 64 108 294.688883 $41913.5200 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 18 20 145.998413 $7299.9300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 43 56 602.585713 $30129.2900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 371 543 446.681042 $22963.9300 $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 2 2 2.000000 $102.8200 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 2.027778 $104.2500 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 936 1176 1234.096760 $63444.9500 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 7 7 4.382572 $225.3000 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 29 34 24.711111 $1270.4000 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 177 202 196.151873 $10084.2000 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 19 22 83.733942 $4304.7600 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 12 13 10.181354 $523.4200 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 7 9 27.935791 $1436.1800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 596 669 693.533156 $35654.5800 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 30 33 42.684126 $2194.3900 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 129 175 101.089677 $5197.0000 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 9 9 9.844445 $506.1100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 211 317 260.585043 $13396.7500 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 7 9 6.961112 $357.8800 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 1 0.672222 $34.5600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 362 467 485.897457 $24980.0100 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 9 11 9.195815 $472.7600 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 14 18 10.299999 $529.5200 $51.4100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 0.364384 $18.7300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 92 123 149.090740 $7664.7800 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 17 21 12.578083 $646.6300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 4 4 3.255556 $167.3700 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 3 2.694445 $138.5200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 373 472 411.475501 $21153.9800 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 20 22 19.698250 $1012.6900 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 105 146 141.416164 $7270.2000 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 221 230 239.243378 $11962.1700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 7 10 23.913089 $361.3300 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1240 1743 1700.548405 $87425.2800 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 19 22 17.885203 $919.4800 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 115 168 123.915078 $6370.4800 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 6 7 4.511110 $231.9100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 58 66 67.650533 $3477.9100 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 13 13 14.267960 $733.5100 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 19 26 19.161721 $985.1100 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1035 1434 1146.358003 $58934.4000 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 38 47 63.322644 $3255.4200 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 26 37 26.072223 $1340.3800 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 10 12 8.842085 $454.5700 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 2.727778 $140.2400 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 75 91 80.115066 $4118.7000 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 11 4.704871 $241.8800 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 76 110 1803.752379 $92730.9300 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 8 9 102.142858 $5251.1600 $51.4100
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Subtotal (Total Children Is Unduplicated) 13147 27226 42764.509523 $2571873.5300 $60.1400
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 3 3.177778 $134.7700 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 478 630 1360.089854 $6800450.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 26 26 228.103218 $11405.1600 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 13 15 234.919842 $16291.7000 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 5.147793 $357.0000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 97 116 233.212378 $54016.5400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4431 6731 6921.320925 $346066.8800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 391 518 364.872342 $18243.6300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1305 1754 1668.621970 $41715.5900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5539 8286 31256.780217 $1562839.2200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 300 401 1578.711115 $78935.5600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 347 477 1428.001157 $35700.0500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4576 6723 18945.365583 $947268.2300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 234 304 908.840474 $45442.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 180 368 942.939054 $23573.4900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1988 3100 10644.181549 $532209.2000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 136 211 543.655913 $27182.7900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 81 180 508.622228 $12715.5700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6078 8525 23834.922181 $1191746.1100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 290 372 1133.619047 $56680.9500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 365 483 1517.762316 $37944.0900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 84 121 5371.742857 $134293.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 475 1087 15097.925346 $377448.1400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1161 1492 26008.480552 $1300424.1300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 21.142857 $1057.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 18613 29794 434401.193290 $21720063.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2425 3358 52347.218953 $2617361.4100 $50.0000
INTR -T1013 INTERPRETER 815 1194 4919.940121 $245996.9900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 10110 20233 250190.281724 $3002283.8400 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 3248 5235 71703.853070 $5159810.3500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 86 108 1264.657934 $91004.7800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 359 548 10075.180534 $580330.4500 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 23 30 311.071427 $17917.7200 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 323 482 6075.580156 $437198.7700 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 15 17 219.332538 $15783.1700 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 2 4 37.019048 $2132.3000 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 2 3 136.571428 $7866.5200 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 2770 4747 62588.307296 $4503855.3600 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 73 96 1198.096824 $86215.0500 $71.9600
PHY -97110HM PT SESSION BY PT ASST 185 309 4793.611891 $275920.3600 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 13 17 226.250001 $13022.9500 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 279 431 5048.541269 $363293.1300 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 25 37 521.215873 $37506.7000 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 2 14.000000 $805.8400 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 2 3 25.571429 $1471.8900 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 17 22 21.034397 $2414.9600 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 16 20 25.122982 $5768.4700 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 17 20 31.251293 $7175.5900 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 32 43 63.955555 $29369.6400 $459.2200
SENS -V5264 EARMOLD 118 178 490.218106 $8887.6400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5440 8863 123066.227711 $8855847.2300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 184 264 3341.114284 $240426.6400 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 16 24 258.321426 $14879.3300 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 4 4 46.428571 $2674.2900 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 342 557 6197.817455 $445994.9900 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 33 43 619.192062 $44557.0800 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 21 30 361.561903 $5047.4100 $13.9600
TRAV -TRAVS Travel by mile 4086 9215 1219200.138531 $542544.0700 $0.4500
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Subtotal (Total Children Is Unduplicated) 28043 127861 2410582.037628 $63039569.5400 $26.1500
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Total 157183 2603833.877690 $70463863.3900 $27.0600
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Number of Children (Unduplicated) With at Least One Authorization 30899