Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2790 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 52 53 59.477779 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 52 53 59.477779 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 6.366667 $732.1700 $115.0000
EXIT -EXIT EXIT ASSESSMENT 63 65 130.000000 $6500.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.233333 $3.5000 $15.0000
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Subtotal (Total Children Is Unduplicated) 69 71 136.600000 $7235.6700 $52.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 11 12 12.900000 $645.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 15 15 15.877776 $793.8800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $690.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 153 158 39.822011 $1991.2900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 16 16 6.544448 $163.6200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 15 16.842855 $842.1400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 9 13.697620 $342.4400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 10 13.942856 $697.1400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 8 6.016666 $150.4200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 4 5.609524 $280.4800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.566667 $14.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 8 8 13.109522 $655.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.016667 $75.4200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 73 76 1717.714286 $42942.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 648 714 4214.557135 $210727.8700 $50.0000
INTR -T1013 INTERPRETER 35 36 92.961905 $4648.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 860 1048 6137.843643 $61378.4400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 103 118 346.426190 $24748.6900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 24 24 66.786902 $3820.2200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 94 105 347.823811 $24848.5100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 8.150000 $465.8500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 5 5 6.600000 $1504.8000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 3.000000 $1368.0000 $456.0000
SENS -V5264 EARMOLD 21 21 18.022220 $324.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 229 243 793.319047 $56674.7300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 4 10.714287 $148.7100 $13.8800
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Subtotal (Total Children Is Unduplicated) 1062 2666 13916.866038 $446007.6300 $32.0500
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Total 2790 14112.943817 $453243.3000 $32.1200
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Number of Children (Unduplicated) With at Least One Authorization 1105