Summary Report for FSPSAs Ending During the Report Period Center: 09
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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2067 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 23 24 50.746033 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 23 24 50.746033 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.194444 $3.8300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 0.533333 $12.5300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 0.533333 $7.4000 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 0.533333 $4.8400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.533333 $14.8400 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 0.533333 $45.2500 $84.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.533333 $8.9100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.338889 $7.5900 $22.4000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.285714 $14.2900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 5 12.352381 $617.6300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.455556 $125.3600 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 13 27 22.826982 $1066.6500 $46.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.011111 $5055.5000 $4999.9500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 0.527778 $26.3900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.142857 $225.0600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 238 288 265.128539 $13256.4400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 98 101 80.744176 $2018.6100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 51 54 58.590475 $2929.5200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 25 28 34.471540 $1723.6000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.033333 $25.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 40 43 36.961959 $1848.1000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 51 53 48.217567 $2410.8700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.250000 $56.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 763 840 4693.114255 $234655.8700 $50.0000
INTR -T1013 INTERPRETER 3 3 41.714286 $2085.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 95 102 588.328571 $42030.2200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 146 152 884.342858 $63177.4400 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 4 4 1.722222 $31.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 299 335 1865.490463 $133270.7600 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1091 2016 8609.791990 $505538.1700 $58.7200
-------------------------------------------------------------------------------------------------------------------------------------
Total 2067 8683.365005 $506604.8200 $58.3400
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1109