Summary Report for FSPSAs Ending During the Report Period Center: 06
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2005 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 45 47 55.966667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 45 47 55.966667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 3.000000 $345.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 28 28 63.142857 $3157.1500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.210959 $3.1700 $15.0000
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Subtotal (Total Children Is Unduplicated) 32 32 66.353816 $3505.3100 $52.8300
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 8 12.155556 $607.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 18 27.566667 $1378.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 82 84 18.065061 $903.3500 $50.0100
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 4 1.016668 $50.8400 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 54 57 12.323512 $308.1300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 3.066666 $153.3300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 2.050000 $102.5000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 6 6.133334 $153.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 4.200000 $210.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 6 8.266667 $206.6700 $25.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 1.666667 $83.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.700000 $17.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 3.300000 $165.0000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.383333 $19.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 5.033333 $125.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 44 45 1030.857143 $25771.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 388 401 2407.609540 $120380.4900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 117 122 667.633339 $33381.6400 $50.0000
INTR -T1013 INTERPRETER 26 27 53.666667 $2683.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 634 739 4497.633367 $44976.3300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 60 230.297617 $16452.4700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 13 14 30.299999 $2164.6200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 8 8 21.650000 $1238.3700 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 4 4 4.328571 $247.6000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 64 70 262.750001 $18770.8400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 10 10 22.688095 $1620.8300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 7 25.714286 $1469.8200 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 4 16.435715 $939.4600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 1.410959 $91.7200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.210959 $24.0500 $114.0200
SENS -V5060 BEHIND EAR HEARING AID 3 3 3.000000 $684.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.500000 $228.0000 $456.0000
SENS -V5264 EARMOLD 19 19 31.577778 $568.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 134 140 543.661903 $38839.1700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 42 43 183.607140 $13116.9000 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 3.785714 $270.4500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 111.285713 $1544.6500 $13.8800
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Subtotal (Total Children Is Unduplicated) 804 1926 10256.531970 $329949.6500 $32.1700
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Total 2005 10378.852453 $333454.9600 $32.1300
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Number of Children (Unduplicated) With at Least One Authorization 845