Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 1389 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 4 4 1.877778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 1.877778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 5.343988 $74.1200 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 6 5.343988 $48.5200 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 5 4.343988 $120.8900 $27.8300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 5.343988 $119.7100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 0.769864 $34.6500 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 6 0.843836 $97.0500 $115.0100
EXIT -EXIT EXIT ASSESSMENT 6 6 6.000000 $300.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 12 12.000000 $612.6000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 73 75 76.966666 $3848.3300 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 23 24 24.000000 $1225.2000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $133.6500 $44.5500
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Subtotal (Total Children Is Unduplicated) 125 163 151.956318 $7023.1200 $46.2200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.777778 $8889.0000 $5000.0600
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 5.566666 $278.3300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 11 12 19.950000 $997.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.750000 $18.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 223 280 670.976200 $33548.8600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 130 150 348.766673 $17438.3700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 71 72 169.833334 $8491.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 166 176 399.158338 $19957.9400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 208 219 1167.302377 $58365.1600 $50.0000
INTR -T1013 INTERPRETER 6 6 78.904761 $3945.2400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 61 255.480950 $18251.5400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 5.142857 $367.4100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 16 16 71.666667 $4099.3300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 46 46 203.420240 $14532.3300 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 5.777778 $1317.3400 $228.0000
SENS -V5264 EARMOLD 6 6 4.522222 $81.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 143 159 907.045233 $64799.3300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.964286 $68.8900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 36.704762 $509.4600 $13.8800
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Subtotal (Total Children Is Unduplicated) 427 1222 4353.711122 $255957.8500 $58.7900
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Total 1389 4507.545218 $262980.9700 $58.3400
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Number of Children (Unduplicated) With at Least One Authorization 476