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: 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 547 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 29 29 42.000001 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 29 42.000001 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.138889 $1.9300 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.138889 $1.2600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.138889 $3.8700 $27.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.138889 $2.3200 $16.7000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 3.366667 $168.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 5 8 4.922223 $227.7100 $46.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.100000 $5.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 89 120 146.982135 $7349.1200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 29 29 19.332269 $483.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 24 24 28.761112 $1438.0600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 28 51.891270 $2594.5700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 19 19 27.609523 $1380.4800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 3.000000 $75.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 26 26 27.276191 $1363.8200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.000000 $75.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 163 168 937.599989 $46880.0500 $50.0000
INTR -T1013 INTERPRETER 1 1 1.000000 $50.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 14 84.633334 $6046.2000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 18 19 103.033333 $7360.7000 $71.4400
SENS -V5264 EARMOLD 1 1 0.277778 $5.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 48 53 294.380950 $21030.6100 $71.4400
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Subtotal (Total Children Is Unduplicated) 313 510 1729.877884 $101136.9000 $58.4600
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Total 547 1776.800108 $101364.6100 $57.0500
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Number of Children (Unduplicated) With at Least One Authorization 342