Summary Report for FSPSAs Initiated During the Report Period Center: 06
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting between: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2373 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 47 47 38.068253 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 47 47 38.068253 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 4 4 8.000000 $400.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
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Subtotal (Total Children Is Unduplicated) 6 6 10.000000 $530.0000 $53.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 19 28.566665 $1428.3300 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 123 126 35.150490 $1757.6400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 2.071429 $103.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 127 133 38.767880 $969.2400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 11.183334 $559.1700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 1.200000 $60.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 9 14.650000 $366.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 7.200000 $360.0000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 0.500000 $25.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 6.433333 $160.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 7.716666 $385.8300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.700000 $35.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 4 5.383334 $134.5900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 4.000000 $100.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 30 31 881.285716 $22032.1500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 6.571428 $328.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 648 716 4133.933295 $206696.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 20 111.371427 $5568.5800 $50.0000
INTR -T1013 INTERPRETER 49 50 180.928571 $9046.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 758 884 5051.514240 $50515.1700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 47 48 172.952382 $12355.7300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 10.071428 $719.5000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 13 16 76.571429 $4379.8900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 2.142857 $122.5700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 45 49 170.028574 $12146.8400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 3 9.714286 $693.9900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 21 25 69.564284 $3976.3000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 3 13.285714 $759.4200 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.000000 $912.0000 $456.0000
SENS -V5264 EARMOLD 13 13 22.299999 $401.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 101 108 345.757148 $24700.9000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 17 18 67.642855 $4832.4100 $71.4400
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Subtotal (Total Children Is Unduplicated) 941 2320 11493.158764 $367094.0700 $31.9400
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Total 2373 11541.227017 $367624.0700 $31.8500
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Number of Children (Unduplicated) With at Least One Authorization 975