Summary Report for FSPSAs Ending During the Report Period Center: 01
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 7474 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 88 90 133.012697 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.233333 $8.6800 $37.1900
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Subtotal (Total Children Is Unduplicated) 89 91 133.246030 $8.6800 $0.0700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 44 50 56.069548 $2719.3700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 12 12 13.597717 $762.8300 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 5.000000 $97.5500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 4.000000 $94.6800 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 5 5.000000 $73.4000 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 3.000000 $66.2100 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 4.000000 $28.8000 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 3.000000 $86.7600 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 4.000000 $180.3200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 3.000000 $41.4300 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 5.742465 $120.8200 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 2.000000 $173.8800 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.295891 $104.0500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.224657 $26.0200 $115.8300
EXIT -EXIT EXIT ASSESSMENT 61 64 64.865362 $3243.2800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 12 21.000000 $1575.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 17 33.500000 $2512.5000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 18 35.500000 $1970.2500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 4 8.000000 $444.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 61 62 122.500000 $9187.5000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 33 34 68.000000 $5100.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 46 46 89.500000 $6712.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 12 13 25.000000 $1875.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 64 65 127.500000 $9562.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 23 24 48.000000 $3600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 333 336 661.142857 $36693.4300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 143 150 293.666667 $16298.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 364 477 918.320482 $68874.0500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 123 146 288.500000 $21637.5000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 10 10 10.000000 $514.1000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 4.000000 $205.6400 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.057534 $2.9600 $51.3800
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 2.153424 $32.5400 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 8 8 8.000000 $411.2800 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 5.214286 $268.0700 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 5 6 52.571429 $2782.6000 $52.9300
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Subtotal (Total Children Is Unduplicated) 857 1633 3037.922319 $200931.2300 $66.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 39 40 45.319385 $226597.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.177626 $108.8900 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 6.428571 $445.8200 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 13 13 27.059882 $6267.6100 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 419 482 498.793764 $24939.6900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 22 27 1.587676 $79.3500 $49.9800
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 67 71 131.156557 $3278.9100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 177 191 345.179370 $17258.9900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 23 23 34.516667 $1725.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 9 8.866668 $221.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 61 66 119.121430 $5956.0800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 4 5 5.483333 $274.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 2.600000 $65.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 75 81 137.705557 $6885.2900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 12 12 17.766666 $888.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 8.633334 $215.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 128 138 231.305564 $11565.3200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 15 16 20.050000 $1002.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 17.266667 $431.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 104 109 761.895238 $38094.7700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 801 880 5733.566675 $286678.3900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 87 91 566.028569 $28301.4500 $50.0000
INTR -T1013 INTERPRETER 217 272 534.721429 $26736.0700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1078 1432 8763.750013 $87637.5300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 36 40 226.776191 $16318.8200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 5.571429 $400.9200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 4 15.285714 $1099.9600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 91 100 601.959524 $43317.0100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 3 26.142857 $1881.2400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 1.714286 $98.6800 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 12.285714 $884.0800 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 14.714285 $1058.8400 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 0.358904 $41.2100 $114.8100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 8 8 8.129224 $147.3800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 116 125 818.842855 $58923.9600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 10 72.671429 $5229.4400 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 8 10 53.428570 $3844.7300 $71.9600
TRAV -TRAVS Travel by mile 1103 1462 8877.178584 $3950.3500 $0.4500
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Subtotal (Total Children Is Unduplicated) 1356 5750 28758.040207 $913771.2000 $31.7700
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Total 7474 31929.208556 $1114711.1100 $34.9100
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Number of Children (Unduplicated) With at Least One Authorization 1922