Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 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 2055 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 49 49 55.152589 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 49 49 55.152589 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $119.6000 $119.6000
EXIT -EXIT EXIT ASSESSMENT 14 14 28.000000 $1400.0000 $50.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 2.000000 $102.1000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 16 16 31.000000 $1621.7000 $52.3100
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 3.677778 $183.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 11 11 12.320635 $616.0400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 2.347945 $561.6400 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 127 135 11.412067 $570.8000 $50.0200
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 21 21 0.437467 $10.9500 $25.0200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 20 20 27.833334 $1391.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 9 9.099999 $227.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 7 8.349999 $417.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 6.366666 $159.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 12 12 14.766668 $738.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 4.333333 $108.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 17 17 23.016667 $1150.8400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 9.316666 $232.9200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 51 52 1454.857137 $36371.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 385 426 2527.878583 $126393.8000 $50.0000
INTR -T1013 INTERPRETER 29 33 87.604761 $4380.2400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 580 764 4345.962712 $43459.5900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 83 104 354.755947 $25343.8000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 12 12 33.685714 $1926.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 79 88 340.545235 $24328.5200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 8 44.057142 $2518.3100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 0.246575 $16.0300 $65.0100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 5 5 3.347945 $1587.7600 $474.2500
SENS -V5264 EARMOLD 13 13 14.976191 $269.5700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 184 213 826.480945 $59043.8700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 10 12 162.642858 $2257.4800 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 679 1990 10330.320969 $334266.7800 $32.3600
-------------------------------------------------------------------------------------------------------------------------------------
Total 2055 10416.473558 $335888.4800 $32.2500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 728