Summary Report for FSPSAs Initiated During the Report Period Center: 52
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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 557 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 4 4 2.411111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 2.411111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.366667 $5.3800 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.366667 $2.6400 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.366667 $10.6100 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.366667 $7.7200 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.030137 $1.3600 $45.2600
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.030137 $3.4900 $115.6700
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 2 7 2.526942 $82.6000 $32.6900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 8.600000 $430.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 180 215 490.049997 $24502.4900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 110 130 356.823809 $17841.1900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 66 74 195.833336 $9791.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 102 104 223.200000 $11160.0000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 2.766667 $138.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 11.366666 $284.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3 3 19.857143 $992.8600 $50.0000
INTR -T1013 INTERPRETER 1 1 1.000000 $50.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 1.733333 $124.7300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 2 2 8.047619 $579.1100 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 1 1 0.122222 $2.2200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 10.400000 $748.3800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 8.400000 $604.4600 $71.9600
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Subtotal (Total Children Is Unduplicated) 238 546 1339.200792 $67708.8200 $50.5600
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Total 557 1344.138845 $67791.4300 $50.4300
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Number of Children (Unduplicated) With at Least One Authorization 242