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 1843 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 89 112 73.754760 $3577.0900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.261111 $14.6500 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.144444 $2.8200 $19.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 0.644444 $14.2200 $22.0700
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 4.000000 $180.3200 $45.0800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $21.0400 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.305556 $59.1700 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.305556 $35.3900 $115.8300
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 98 126 84.415871 $4054.7000 $48.0300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 12 18.827778 $94139.0000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 3.161111 $158.0600 $50.0000
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 2 2 10.819047 $540.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 29 30 161.510320 $8075.5300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 10.395238 $519.7700 $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 11 11 51.130158 $3679.3200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.866667 $134.3300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 3 3 15.390476 $1107.4900 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 1.857143 $133.6400 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 4.714286 $339.2400 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.305556 $140.3400 $459.2900
SENS -V5264 EARMOLD 1 1 0.305556 $5.5400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 14 78.958730 $5681.8600 $71.9600
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Subtotal (Total Children Is Unduplicated) 570 1709 3842.740479 $172604.7600 $44.9200
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Total 1843 3933.341272 $176659.4600 $44.9100
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Number of Children (Unduplicated) With at Least One Authorization 575