Summary Report for FSPSAs Ending During the Report Period Center: 54
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1969 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 3 3 3.199999 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 3.199999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 30 33 24.444447 $1185.5700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.156164 $8.8200 $56.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.733333 $41.0800 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 7 7 9.155555 $776.7500 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.400000 $8.9600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 11 10.200000 $459.0000 $45.0000
EXIT -EXIT EXIT ASSESSMENT 49 52 101.293074 $5064.6600 $50.0000
SCREEN-T1023 SCREENING 6 6 3.455556 $172.7800 $50.0000
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.088889 $3.2000 $35.9800
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Subtotal (Total Children Is Unduplicated) 100 114 150.927018 $7720.8200 $51.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 24 28 41.186835 $205934.5000 $5000.0100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.427778 $102.2400 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 98 113 111.145587 $5557.2900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 3.255556 $81.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 52 58 38.080156 $1904.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 79 86 61.367085 $3068.3600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.238889 $5.9700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 59 64.188888 $3209.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 123 131 85.527776 $4276.3800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 3.850001 $96.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 326 360 1830.400788 $91520.0300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 454 857 2727.054004 $27270.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 50 229.077779 $16365.3400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 11.111111 $635.5500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 39 46 195.344443 $13955.4000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 12.516667 $715.4500 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.200000 $91.2000 $456.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 37 43 193.803174 $13845.3100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.000000 $357.2000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.888889 $508.4500 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 4.428572 $61.4700 $13.8800
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Subtotal (Total Children Is Unduplicated) 465 1852 5628.093978 $389561.7600 $69.2200
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Total 1969 5782.220995 $397282.5800 $68.7100
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Number of Children (Unduplicated) With at Least One Authorization 473