Summary Report for FSPSAs Ending During the Report Period Center: 07
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 2099 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 21 21 25.433332 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 21 25.433332 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 2.000000 $97.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 10 10 13.000000 $734.3700 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 11 11 18.205556 $427.6500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 5 7.000000 $97.0900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 9 13.000000 $308.1000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 16 16 15.733333 $142.8600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 24 24 21.115068 $587.6300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 6.733333 $571.2500 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 0.982648 $50.1900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 31 31 31.000000 $517.7000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 3.733333 $83.6300 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.863927 $128.8800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 2.000000 $230.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 82 83 92.019481 $4600.9700 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.095890 $7.2000 $75.0900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 8.095890 $449.3300 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 23 23 14.438356 $801.3400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 23 23 14.438356 $1082.9000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 7.571429 $386.5200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 14.285714 $729.2900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 27 27 36.033691 $1839.5100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.472222 $24.1100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 9.000000 $459.4500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 13 8.271615 $422.2700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 3.361111 $171.5800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 51 52 41.920927 $2140.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 2.803044 $124.8700 $44.5500
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Subtotal (Total Children Is Unduplicated) 267 385 394.174924 $17394.7700 $44.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.210959 $6055.0000 $5000.1700
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.666667 $33.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 6 4.916894 $245.8500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.833333 $59.6700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 8.800000 $2024.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 140 165 131.681525 $6584.1500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 16 18 10.922223 $273.0600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 233 270 533.845229 $26692.2500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 4.004167 $100.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 55 59 93.611905 $4680.6000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.166667 $54.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 35 71.204761 $3560.2500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 114 125 195.414292 $9770.7500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 8.685714 $217.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 716 774 5844.297611 $292214.9200 $50.0000
INTR -T1013 INTERPRETER 2 3 11.285714 $564.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 46 48 360.285714 $25738.7800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 8.285714 $591.9400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 8.571429 $490.2800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 32 34 219.766668 $15700.1400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 5.428571 $387.8200 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.600000 $729.6000 $456.0000
SENS -V5264 EARMOLD 1 1 1.388889 $25.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 114 121 894.499993 $63903.0600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 16.428572 $1173.6500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.714286 $98.0600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 5 6 49.428571 $686.0700 $13.8800
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Subtotal (Total Children Is Unduplicated) 808 1693 8490.946068 $462653.9200 $54.4900
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Total 2099 8910.554324 $480048.6900 $53.8700
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Number of Children (Unduplicated) With at Least One Authorization 883