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 644 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 42 43 46.455557 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 43 46.455557 $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
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Subtotal (Total Children Is Unduplicated) 1 4 2.044444 $34.4900 $16.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 112 147 178.677423 $8933.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 40 26.856924 $671.4200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 42 42 51.696826 $2584.8500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 28 29 38.568254 $1928.4100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 20 21 34.334920 $1716.7500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 36 36 42.128571 $2106.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.000000 $75.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 156 163 1000.909538 $50045.4500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 17 17 92.419049 $6602.4100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 21 21 140.366668 $10027.7900 $71.4400
SENS -V5264 EARMOLD 1 1 1.022222 $18.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 71 75 465.085724 $33225.7200 $71.4400
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Subtotal (Total Children Is Unduplicated) 350 597 2077.066119 $122961.5000 $59.2000
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Total 644 2125.566120 $122995.9900 $57.8700
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Number of Children (Unduplicated) With at Least One Authorization 389