Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1417 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 41 41 39.587302 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 41 41 39.587302 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.000000 $8.7500 $8.7500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.066667 $3.1200 $46.8200
EXIT -EXIT EXIT ASSESSMENT 12 12 24.000000 $1200.0000 $50.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 15 15 27.066667 $1313.9700 $48.5500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.060274 $5301.5000 $5000.1200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.355556 $17.7800 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 4.333334 $216.6700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.079452 $19.0200 $239.3400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 142 156 22.882292 $1144.3100 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 18 19 0.373579 $9.3500 $25.0300
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 17 18.383334 $919.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 3.016667 $75.4200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 10 13.516667 $675.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.566667 $39.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 12 13 18.499999 $925.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 2.850000 $71.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 17 19 26.731508 $1336.5800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.450000 $11.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 123 134 781.014286 $39050.7000 $50.0000
INTR -T1013 INTERPRETER 33 35 77.747619 $3887.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 586 747 4079.643189 $40796.4000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 31 33 108.803572 $7772.9300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 5 7.814285 $446.9800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 39 41 141.021427 $10074.5700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 5 14.821428 $847.1900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 0.561644 $36.5100 $65.0100
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.079452 $18.8500 $237.2600
SENS -V5264 EARMOLD 4 4 0.955555 $17.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 85 88 346.573806 $24759.2700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 200.000000 $2776.0000 $13.8800
TRAV -TRAVS Travel by mile 1 1 1.900000 $0.8500 $0.4500
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Subtotal (Total Children Is Unduplicated) 656 1361 5875.035592 $141247.1100 $24.0400
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Total 1417 5941.689561 $142561.0800 $23.9900
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Number of Children (Unduplicated) With at Least One Authorization 697