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 668 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 50 51 75.746033 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 50 51 75.746033 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
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
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Subtotal (Total Children Is Unduplicated) 1 6 1.166664 $34.0500 $29.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.142857 $10714.5000 $5000.1000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 89 142 228.505480 $11425.2700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 22 31 36.000000 $900.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 69 71 72.150000 $3607.5000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 3.900000 $97.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 49 49 53.596032 $2679.8000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 26 27 38.962699 $1948.1400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 59 59 57.955556 $2897.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.233333 $30.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 112 115 716.147628 $35807.3300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 20 106.814286 $7630.8200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 23 26 170.661904 $12192.0900 $71.4400
SENS -V5264 EARMOLD 1 1 0.194444 $3.5000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 57 63 353.261910 $25237.0200 $71.4400
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Subtotal (Total Children Is Unduplicated) 331 611 1841.526129 $115172.0600 $62.5400
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Total 668 1918.438826 $115206.1100 $60.0500
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Number of Children (Unduplicated) With at Least One Authorization 378