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 627 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 27 27 53.571427 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 27 53.571427 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.000000 $9.0800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.088889 $1.4800 $16.7000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 9.571428 $478.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 1.466667 $73.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 7 10 14.126984 $604.1700 $42.7700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 76 125 177.674637 $8883.7400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 54 71 79.034632 $1975.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 35 35 37.755556 $1887.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 27 39.588890 $1979.4500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 29 29 29.744523 $1487.2400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 43 45 68.420711 $3421.0400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 146 151 860.017455 $43000.9100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 18 123.909523 $8852.1200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 21 22 108.733332 $7767.9100 $71.4400
SENS -V5264 EARMOLD 1 1 0.177778 $3.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 59 65 407.021426 $29077.6200 $71.4400
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Subtotal (Total Children Is Unduplicated) 332 590 1933.078463 $108361.8600 $56.0600
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Total 627 2000.776874 $108966.0300 $54.4600
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Number of Children (Unduplicated) With at Least One Authorization 364