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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2295 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 53 54 79.434922 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 53 54 79.434922 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.194444 $4.5700 $23.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.194444 $4.5700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.194444 $2.8300 $14.5800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.194444 $1.9000 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.194444 $5.5800 $28.7100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.194444 $16.4900 $84.8200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.194444 $2.6700 $13.7100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.072222 $3.6100 $49.9800
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 6.142857 $307.1400 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 7 13 8.576187 $400.4200 $46.6900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.515079 $12575.5000 $5000.0400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 165 259 368.500078 $18425.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 163 242 256.675239 $6416.8800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 93 96 93.805556 $4690.2800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 8 7.061111 $176.5300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 60 60 62.496033 $3124.8100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.061111 $1.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 36 49.946032 $2497.3000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.061111 $1.5300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 77 78 74.516668 $3725.8400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 5.233333 $130.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 681 764 4777.208752 $238860.4000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 127 139 860.566673 $61478.8700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 154 168 1064.576197 $76053.3000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 8.571428 $612.3500 $71.4400
SENS -V5264 EARMOLD 1 1 0.194444 $3.5000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 320 364 2269.657157 $162144.2800 $71.4400
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Subtotal (Total Children Is Unduplicated) 1016 2228 9901.646002 $590918.7200 $59.6800
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Total 2295 9989.657111 $591319.1400 $59.1900
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Number of Children (Unduplicated) With at Least One Authorization 1062