Summary Report for FSPSAs Initiated During the Report Period Center: 09
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 2320 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 30 30 42.973017 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 30 30 42.973017 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.333333 $7.8300 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.333333 $7.8300 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.333333 $4.8600 $14.5800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.333333 $3.2600 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.333333 $9.5700 $28.7200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.333333 $4.5700 $13.7100
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 5 10.938096 $546.9100 $50.0000
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Subtotal (Total Children Is Unduplicated) 6 11 12.938094 $584.8300 $45.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.388889 $16944.5000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 190 277 361.346633 $18067.3600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 158 210 220.366488 $5509.1600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 59 60 54.205554 $2710.2700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.500000 $37.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 48 50 44.427777 $2221.3900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 28 29 30.594443 $1529.7200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 59 62 70.212697 $3510.6300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 766 844 5255.509474 $262775.6500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 4 10.714285 $535.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 157 176 1118.390467 $79897.8700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.533333 $38.1000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 136 155 912.972216 $65222.8000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 3 38.285714 $2735.1300 $71.4400
SENS -V5264 EARMOLD 1 1 0.333333 $6.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 342 394 2452.633304 $175216.2500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 6.571428 $469.4700 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 4.642857 $331.6900 $71.4400
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Subtotal (Total Children Is Unduplicated) 1059 2279 10588.628892 $637809.1800 $60.2400
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Total 2320 10644.540003 $638394.0200 $59.9700
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Number of Children (Unduplicated) With at Least One Authorization 1083