Summary Report for FSPSAs Initiated During the Report Period Center: 09
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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 161 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 11 11 11.974603 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 11 11.974603 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.183333 $8.2500 $44.9900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.183333 $21.0800 $114.9800
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Subtotal (Total Children Is Unduplicated) 1 2 0.366666 $29.3300 $79.9900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 53 67 45.968791 $2298.4600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 15 15 3.132229 $78.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 9 1.380820 $69.0300 $49.9900
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.011111 $0.5600 $49.9500
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 8 1.358598 $67.9200 $49.9900
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 0.055555 $2.7800 $49.9500
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 18 18 69.214288 $3460.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 6 19.214286 $1372.6600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 10 10 88.580953 $6328.2200 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.183333 $41.7900 $227.9600
SENS -V5264 EARMOLD 1 1 0.183333 $3.3000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 10 53.642857 $3832.2500 $71.4400
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Subtotal (Total Children Is Unduplicated) 89 148 282.926154 $17555.9800 $62.0500
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Total 161 295.267423 $17585.3100 $59.5600
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Number of Children (Unduplicated) With at Least One Authorization 97