Summary Report for FSPSAs Ending During the Report Period Center: 53
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: 07-01-20 and 06-30-21 Date of Report: 07-15-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1155 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 36 42 75.805555 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 36 42 75.805555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 10 8.555555 $414.9400 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 6 7.072222 $167.6100 $23.7000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.011111 $51.6400 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.027778 $23.0200 $22.4000
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 19 19 19.666666 $757.2100 $38.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.133333 $5666.5000 $4999.8500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.855556 $142.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 7.000000 $1610.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 21 27 23.546826 $1177.3500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 44 47 36.249999 $1812.5100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 13.295237 $664.7600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 12 14 49.350001 $2467.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 20.361904 $509.0500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 81 88 205.845239 $10292.2600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 89 104 309.784124 $15489.2000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 16 16 45.522221 $1138.0500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 26 27 66.538890 $3326.9500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 35 42 139.466667 $6973.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 16.400000 $410.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 73 83 190.946032 $9547.3000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 67 77 162.149203 $8107.4400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 21 22 31.038890 $775.9800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 7.285714 $182.1400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 7 27.945237 $1397.2600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 30 35 388.828570 $19441.4400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 26 30 341.571429 $17078.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 350 431 2440.431731 $24404.3300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 4 25.142857 $1796.2000 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 31.657143 $2261.5800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 4 25.842857 $1846.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 8.285714 $473.6100 $57.1600
SENS -V5264 EARMOLD 1 1 2.000000 $36.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 3 18.419048 $1315.8600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 21.466666 $1533.5700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 5 83.714285 $5980.5500 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 7.142857 $264.2900 $37.0000
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Subtotal (Total Children Is Unduplicated) 611 1094 4752.218230 $148147.5600 $31.1700
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Total 1155 4847.690451 $148904.7700 $30.7200
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Number of Children (Unduplicated) With at Least One Authorization 637