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: 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 2376 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 34 36 75.109526 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 34 36 75.109526 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.550000 $12.9300 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 0.550000 $12.9300 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 0.550000 $8.0200 $14.5800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 0.550000 $5.3800 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.550000 $15.8000 $28.7200
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.383333 $32.5200 $84.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.550000 $7.5400 $13.7100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.633333 $81.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 6 22.371428 $1118.5800 $50.0000
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Subtotal (Total Children Is Unduplicated) 9 20 27.688094 $1295.3500 $46.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 2.372222 $11861.0000 $4999.9500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 182 270 343.775204 $17188.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 157 215 230.078850 $5751.9800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 83 83 97.351587 $4867.5800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 1.161111 $29.0300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 69 69 61.172221 $3058.6100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 2.216667 $55.4200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 36 36 34.053178 $1702.6800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.444444 $11.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 73 74 71.916667 $3595.8400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.505556 $37.6400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 728 838 5235.857155 $261792.6300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 29.142857 $1457.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 157 179 1123.161909 $80238.5900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 9.285714 $663.3700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 128 148 941.538899 $67263.5000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 3 19.000000 $1357.3500 $71.4400
SENS -V5264 EARMOLD 2 2 0.550000 $9.9000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 327 386 2368.143665 $169180.0200 $71.4400
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Subtotal (Total Children Is Unduplicated) 1009 2320 10572.727906 $630122.1500 $59.6000
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Total 2376 10675.525526 $631417.5000 $59.1500
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Number of Children (Unduplicated) With at Least One Authorization 1039