Summary Report for FSPSAs Initiated During the Report Period Center: 54
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 2640 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 5 5 4.544444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 4.544444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 46 53 56.850000 $2757.2300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 11 9.140334 $516.3400 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 0.855556 $11.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 0.816667 $19.3600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 0.855556 $7.7700 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.855556 $23.8100 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 3.305556 $280.4500 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 0.633333 $14.1900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 9 7.277778 $327.5000 $45.0000
EXIT -EXIT EXIT ASSESSMENT 59 64 82.554316 $4127.7200 $50.0000
SCREEN-T1023 SCREENING 8 8 5.355556 $267.7800 $50.0000
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Subtotal (Total Children Is Unduplicated) 135 164 168.500208 $8354.0000 $49.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 27 39.372223 $196861.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 1.400000 $70.0000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 4.666667 $334.1800 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.622223 $44.5600 $71.6200
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 1.450000 $333.5000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 127 140 120.365085 $6018.2900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 4.255556 $106.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 63 73 63.816667 $3190.8400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 112 115 82.757559 $4137.8700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.691667 $17.2900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 101 103 80.994445 $4049.7300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 142 146 114.242858 $5712.1500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.088889 $77.2200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 438 472 2788.184915 $139409.2500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 35 36 91.946032 $4597.3100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 625 1130 4024.698454 $40246.9900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 70 77 457.365875 $32674.2100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 8.714286 $622.5500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 10.222222 $584.7100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 1.000000 $57.2000 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.857143 $61.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 36 41 185.826191 $13275.4400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 8 8 7.666667 $547.7100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 20.683334 $1182.2600 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.555556 $253.3500 $456.0400
SENS -V5264 EARMOLD 4 4 1.411111 $25.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 52 57 277.398410 $19817.3300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 6.266667 $447.6900 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 0.714286 $51.0300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 17.800000 $247.0600 $13.8800
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Subtotal (Total Children Is Unduplicated) 653 2471 8419.034988 $475054.2300 $56.4300
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Total 2640 8592.079640 $483408.2300 $56.2600
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Number of Children (Unduplicated) With at Least One Authorization 666