Summary Report for FSPSAs Ending During the Report Period Center: 09
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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2265 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 29 29 56.904761 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 29 56.904761 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 0.311111 $7.3100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.311111 $18.1800 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.311111 $11.9000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.038889 $28.9100 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 0.311111 $26.3900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.038889 $1.9900 $51.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 0.400000 $6.6800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.272222 $6.1000 $22.4000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 9.571428 $478.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 9 13.246032 $662.3000 $50.0000
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Subtotal (Total Children Is Unduplicated) 13 29 27.811904 $1248.3400 $44.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 138 205 284.896349 $14244.8100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 200 285 280.135874 $7003.4000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 49 51 50.777778 $2538.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 3.000000 $75.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 34 35 48.605556 $2430.2800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 48 48 45.822300 $2291.1200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 56 59 82.754045 $4137.7100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 6 5.344444 $133.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 782 849 5081.753950 $254087.7800 $50.0000
INTR -T1013 INTERPRETER 1 1 8.285714 $414.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 126 137 889.033334 $63512.5600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 7.428571 $530.7000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 142 152 878.467456 $62757.7500 $71.4400
SENS -V5264 EARMOLD 2 2 0.216667 $3.9000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 341 372 2422.239672 $173044.7600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 12.142857 $867.4900 $71.4400
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Subtotal (Total Children Is Unduplicated) 1117 2207 10101.904567 $593074.0400 $58.7100
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Total 2265 10186.621232 $594322.3800 $58.3400
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Number of Children (Unduplicated) With at Least One Authorization 1144