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: 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 1980 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 6 6 8.221429 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 9.714286 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 7 7 17.935715 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 44 50 58.519047 $2838.1700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.9800 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.888889 $12.3300 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.888889 $8.0700 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.888889 $24.7400 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.088889 $7.5400 $84.8500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.155556 $25.8900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.633333 $28.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.088889 $125.2200 $115.0000
EXIT -EXIT EXIT ASSESSMENT 39 42 58.085539 $2904.2700 $50.0000
SCREEN-T1023 SCREENING 2 2 0.677777 $33.8900 $49.9900
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 90 105 124.915697 $6121.5900 $49.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 10.000000 $50000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.066667 $53.3400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.627778 $44.9600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 1.611111 $370.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 111 126 108.458333 $5422.9200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 9 10 10.250000 $512.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 7.000000 $175.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 64 70 84.933334 $4246.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 105 110 81.249999 $4062.5000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 4 2.200000 $110.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.291666 $57.2900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 88 91 62.652781 $3132.6600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 2 2 1.211111 $60.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 178 187 121.233329 $6061.6500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 3 3 4.011111 $200.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 3.522222 $88.0600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 52 59 289.713495 $14485.6700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 25.742857 $1287.1400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 597 1127 3657.758730 $36577.5900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 28.338096 $2024.4700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.000000 $142.8800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 13 14 53.271430 $3805.7200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 0.666667 $47.6300 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.088889 $40.5400 $456.0600
SENS -V5264 EARMOLD 3 3 1.055556 $19.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 15 57.324604 $4095.2700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.933333 $352.4400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 11.142857 $796.0500 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.571429 $21.1400 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 615 1868 4634.927385 $138294.7100 $29.8400
-------------------------------------------------------------------------------------------------------------------------------------
Total 1980 4777.778797 $144416.3000 $30.2300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 625