Summary Report for FSPSAs Ending During the Report Period Center: 07
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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 924 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 21 21 16.938891 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 21 16.938891 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.377778 $8.8800 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.377778 $8.8800 $23.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.377778 $8.8800 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.377778 $3.7000 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.377778 $10.8500 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.377778 $16.9100 $44.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.377778 $32.6000 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.377778 $7.8900 $20.8900
EXIT -EXIT EXIT ASSESSMENT 23 23 33.100000 $1655.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 27 34 41.122224 $1900.2400 $46.2100
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.133333 $56.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 147 193 112.176347 $5608.9000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 3.000000 $150.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 8 4.971428 $124.2800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 275 324 738.276193 $36913.8300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 8.133333 $406.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 125 131 261.566671 $13078.3600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 45 51 85.921898 $4296.1000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.433333 $10.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 140 142 255.347623 $12767.4100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.966667 $74.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 7 41.399998 $2070.0100 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 1 2 7.857142 $561.3200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 6.285714 $449.0500 $71.4400
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Subtotal (Total Children Is Unduplicated) 355 869 1529.469680 $76567.5700 $50.0600
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Total 924 1587.530795 $78467.8100 $49.4300
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Number of Children (Unduplicated) With at Least One Authorization 381