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
Eligibility Filter: Program Patients
With the filters selected there were 2666 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3 3 3.199999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 48 55 44.733336 $2169.5800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 6.156164 $347.7600 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.711111 $9.8600 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 2.872222 $68.0700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.711111 $6.4600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.711111 $19.7900 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 12 13 12.683333 $1076.0500 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.400000 $31.3600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 14 15 11.477778 $516.5000 $45.0000
EXIT -EXIT EXIT ASSESSMENT 67 72 128.450913 $6422.5500 $50.0000
SCREEN-T1023 SCREENING 7 7 4.166667 $208.3400 $50.0000
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.088889 $3.2000 $35.9800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 146 179 214.162635 $10879.5200 $50.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 34 42 62.792391 $313962.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 1.865829 $93.2900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 1.705556 $122.1400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 2.344444 $539.2100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 128 146 140.066222 $7003.3200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 4.255556 $106.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 71 80 65.885713 $3294.2800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 111 121 98.812323 $4940.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.238889 $5.9700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 81 84 81.338888 $4066.9400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 159 168 118.705555 $5935.2800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 4 4.538890 $113.4800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 397 442 2313.357931 $115667.8700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 5.857143 $292.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 585 1137 3697.111945 $36971.1300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 76 337.866667 $24137.2300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 11.111111 $635.5500 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.857143 $61.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 52 60 279.719047 $19983.1400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 12.516667 $715.4500 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 0.744445 $339.4900 $456.0300
SENS -V5264 EARMOLD 4 5 2.666667 $48.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 73 85 391.559524 $27973.0300 $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 2 2 9.355556 $535.1400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 4.428572 $61.4700 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 601 2484 7654.702674 $567962.2000 $74.2000
-------------------------------------------------------------------------------------------------------------------------------------
Total 2666 7872.065308 $578841.7200 $73.5300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 612