Summary Report for FSPSAs Ending During the Report Period Center: 54
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: 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 2433 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 8 8 6.184922 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 6.184922 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 89 113 74.754760 $3625.5900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 16 16 11.461111 $642.9700 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 2.488889 $48.5600 $19.5100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.061111 $15.5800 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 23 23 11.911108 $262.8700 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.777777 $12.8000 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.944444 $27.3100 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 4.000000 $180.3200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.338889 $4.6800 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 3.000000 $63.1200 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 12 9.250000 $419.2100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.416667 $48.2600 $115.8200
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
SCREEN-T1023 SCREENING 2 2 1.533333 $76.6700 $50.0000
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Subtotal (Total Children Is Unduplicated) 138 187 124.938089 $5527.9300 $44.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 25 36.158730 $180793.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 3.161111 $158.0600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 2.338889 $541.7400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 206 251 192.647621 $9632.3800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 27 29 26.216667 $1310.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 52 58 57.977779 $2898.9000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 0.722222 $36.1100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 115 117 107.810316 $5390.5100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 5 5 6.711111 $335.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 8.049207 $201.2300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 62 47.822222 $2391.1100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 3 3 0.766667 $38.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 163 168 118.780157 $5939.0000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 3 3 2.966667 $148.3400 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 41.514285 $2075.7100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 321 346 1569.661117 $78483.0600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 28 28 149.731745 $7486.5900 $50.0000
INTR -T1013 INTERPRETER 1 2 12.428572 $621.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 522 923 2900.599205 $29005.9800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 36 37 206.131746 $14833.2400 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 16.647620 $1197.9700 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 25 25 133.382540 $9598.2000 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 2.285714 $164.4800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 36 36 162.982542 $11728.2100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 3 6.604762 $475.2700 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 27 30 90.158729 $6487.8100 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 1.927778 $885.2800 $459.2300
SENS -V5264 EARMOLD 4 4 3.861112 $70.0000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 37 39 205.809522 $14810.0300 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 15 16 106.984127 $7698.5800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 8.847619 $636.6700 $71.9600
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Subtotal (Total Children Is Unduplicated) 578 2238 6231.688101 $396074.0900 $63.5600
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Total 2433 6362.811112 $401602.0200 $63.1200
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Number of Children (Unduplicated) With at Least One Authorization 585