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: 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 2800 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 44 44 57.280955 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 44 44 57.280955 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.433333 $164.8300 $115.0000
EXIT -EXIT EXIT ASSESSMENT 75 76 152.000000 $7600.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.010655 $15.1600 $15.0000
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Subtotal (Total Children Is Unduplicated) 78 80 154.443988 $7779.9900 $50.3700
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 8 9 7.077778 $353.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 19 27.155556 $1357.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 14.566667 $3350.3400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 147 149 32.070033 $1603.7000 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 15 15 5.544448 $138.6200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 14 13.883334 $694.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 13 14 7.494444 $187.3600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 7 9.083333 $454.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 1.850000 $46.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 1.666667 $83.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 0.600000 $15.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 8 8 6.633334 $331.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 4.544444 $113.6100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 44 45 1365.142857 $34128.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 682 738 4786.366662 $239318.3500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 8 25.857143 $1292.8600 $50.0000
INTR -T1013 INTERPRETER 34 38 137.247618 $6862.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 884 1061 6618.805548 $66188.0700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 85 100 340.690477 $24338.9400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.142857 $153.0900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 16 16 72.307144 $4135.9700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 88 102 380.516668 $27184.1100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.000000 $142.8800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 14 15 53.914287 $3081.7400 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 2.232877 $145.1400 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 1.232877 $140.5500 $114.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.433333 $326.7900 $227.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 8 8 15.244445 $6951.4900 $456.0000
SENS -V5264 EARMOLD 22 22 28.266668 $508.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 211 244 840.328569 $60033.0700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 8.678572 $619.9900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 8 9 86.071430 $1194.6700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1027 2676 14900.650070 $485477.3400 $32.5800
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Total 2800 15112.375013 $493257.3300 $32.6400
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Number of Children (Unduplicated) With at Least One Authorization 1089