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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2373 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 37 37 56.784918 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 37 37 56.784918 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.244444 $11.0000 $44.9900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.244444 $28.1100 $114.9800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 7.719047 $385.9500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 10 29.236509 $1461.8300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 13 16 39.444444 $1988.9800 $50.4200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 260 329 415.303149 $20765.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 126 132 107.186403 $2679.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 57 60 68.516657 $3425.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 50 55 77.382399 $3869.1200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 1.400000 $35.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 49 53 58.752381 $2937.6300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 0.600000 $15.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 60 60 57.946164 $2897.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 5.600000 $140.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 831 921 5760.064255 $288003.3300 $50.0000
INTR -T1013 INTERPRETER 1 1 3.000000 $150.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 93 114 597.333326 $42673.5100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 154 169 996.297614 $71175.5800 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.244444 $55.7200 $227.9600
SENS -V5264 EARMOLD 1 1 0.244444 $4.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 372 409 2670.209514 $190759.8400 $71.4400
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Subtotal (Total Children Is Unduplicated) 1195 2320 10823.080750 $634637.1400 $58.6400
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Total 2373 10919.310112 $636626.1300 $58.3000
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Number of Children (Unduplicated) With at Least One Authorization 1228