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: 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 575 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 18 18 26.406349 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 18 18 26.406349 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.316667 $6.2400 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.316667 $7.4400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.316667 $4.3900 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.316667 $2.8800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.316667 $8.8100 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.316667 $26.8700 $84.8500
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.316667 $5.2900 $16.7000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 4.571429 $228.5700 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.095890 $4.9000 $51.0600
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Subtotal (Total Children Is Unduplicated) 3 9 6.883988 $295.3900 $42.9100
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.833333 $41.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 100 130 82.287177 $4114.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 24 25 17.124091 $428.1000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 27 28 26.734605 $1336.7300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.466667 $11.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 29 31 43.058556 $2152.9200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.033333 $0.8300 $24.9800
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 40 60.256352 $3012.8300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 47 48 53.673810 $2683.6900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.250000 $31.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 136 139 962.738111 $48136.9000 $50.0000
INTR -T1013 INTERPRETER 1 1 5.714286 $285.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 15 106.714286 $7623.6700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 24 24 197.009524 $14074.3700 $71.4400
SENS -V5264 EARMOLD 1 1 0.316667 $5.7000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 55 60 450.214290 $32163.3200 $71.4400
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Subtotal (Total Children Is Unduplicated) 343 548 2009.425088 $116128.6900 $57.7900
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Total 575 2042.715425 $116424.0700 $56.9900
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Number of Children (Unduplicated) With at Least One Authorization 362