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: 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 2357 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 43 44 49.488890 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 43 44 49.488890 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.511111 $7.0900 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.511111 $4.6400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.511111 $14.2200 $27.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.511111 $8.5400 $16.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 1.244444 $56.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 1.244444 $143.1100 $115.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 10.857143 $542.8600 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 9 39.666668 $1983.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 12 19 55.057143 $2759.7800 $50.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 267 336 416.352248 $20817.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 132 138 109.765474 $2744.1400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 71 73 82.507938 $4125.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 41 42 50.529366 $2526.4700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 42 47.616667 $2380.8500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 64 64 75.040476 $3752.0200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.000000 $75.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 844 905 5403.682626 $270183.9900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 109 127 714.892073 $51071.8300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 143 156 991.295253 $70818.0700 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.244444 $283.7200 $227.9900
SENS -V5264 EARMOLD 2 3 2.266666 $40.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 377 399 2787.709564 $199153.9100 $71.4400
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Subtotal (Total Children Is Unduplicated) 1198 2294 10689.902795 $633048.8600 $59.2200
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Total 2357 10794.448828 $635808.6500 $58.9000
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Number of Children (Unduplicated) With at Least One Authorization 1229