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
Eligibility Filter: Program Patients
With the filters selected there were 2520 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 46 46 44.791271 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 46 46 44.791271 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 3.766667 $433.1700 $115.0000
EXIT -EXIT EXIT ASSESSMENT 74 74 148.000000 $7400.0000 $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) 77 77 152.622223 $7846.0000 $51.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 7 9.199999 $460.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 17 17 16.055556 $802.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.400000 $782.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 155 159 30.914075 $1545.8900 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 8 8 1.034725 $25.8800 $25.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 14 23.823808 $1191.1800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 9 11.523810 $288.1000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 10 16.607142 $830.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 10.073810 $251.8500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 8.928572 $446.4300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 8 8 16.707143 $835.3600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 1.733334 $43.3400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 49 53 1404.000002 $35100.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 612 653 4239.023807 $211951.2500 $50.0000
INTR -T1013 INTERPRETER 22 23 110.676190 $5533.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 796 952 6149.253168 $61492.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 91 100 374.972617 $26788.0500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 12 12 51.523809 $2947.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 93 106 380.059526 $27151.4600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 12.807143 $732.0500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.052055 $3.3900 $65.0600
SENS -V5060 BEHIND EAR HEARING AID 3 3 4.377778 $998.1400 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.800000 $1276.8000 $456.0000
SENS -V5264 EARMOLD 16 16 14.666667 $264.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 189 218 765.857143 $54712.8300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 3 5.428571 $75.3500 $13.8800
TRAV -TRAVS Travel by mile 1 1 7.857143 $3.5000 $0.4400
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Subtotal (Total Children Is Unduplicated) 925 2397 13674.357593 $441533.4300 $32.2900
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Total 2520 13871.771087 $449379.4400 $32.4000
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Number of Children (Unduplicated) With at Least One Authorization 1000