Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1481 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 31 31 33.174605 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 31 31 33.174605 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 44 44 88.000000 $4400.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.855556 $12.8300 $15.0000
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Subtotal (Total Children Is Unduplicated) 45 45 88.855556 $4412.8300 $49.6600
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 1.633333 $81.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 11 11 12.100001 $605.0100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.400000 $322.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 97 98 20.220546 $1011.1500 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 0.012501 $0.3200 $25.2000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 14.390475 $719.5200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 8 7.666667 $191.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 9.957142 $497.8500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 5.266667 $131.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 8.428572 $421.4300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 8.990476 $449.5200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 0.783334 $19.5900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 31 33 990.285716 $24757.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 413 444 2813.561903 $140678.1500 $50.0000
INTR -T1013 INTERPRETER 16 17 76.104761 $3805.2400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 484 567 3545.257933 $35452.5800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 35 40 133.080952 $9507.3100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 22.259524 $1273.2500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 51 56 206.907143 $14781.4500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 12.807143 $732.0500 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.800000 $820.8000 $456.0000
SENS -V5264 EARMOLD 10 10 9.588890 $172.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 67 77 252.642860 $18048.7800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 3 5.428571 $75.3500 $13.8800
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Subtotal (Total Children Is Unduplicated) 552 1405 8160.575110 $254556.0500 $31.1900
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Total 1481 8282.605271 $258968.8800 $31.2700
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Number of Children (Unduplicated) With at Least One Authorization 600