Summary Report for FSPSAs Ending During the Report Period Center: 06
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 1756 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 49 51 55.050793 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 49 51 55.050793 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
EXIT -EXIT EXIT ASSESSMENT 4 4 6.088889 $304.4500 $50.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 1 2 0.666667 $94.8200 $142.2400
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Subtotal (Total Children Is Unduplicated) 6 7 7.755556 $515.0800 $66.4100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 264 275 152.877291 $7643.9400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 20 20 9.808335 $490.4300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 153 162 100.686023 $2517.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 15 16.966668 $848.3400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 2.200000 $110.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 14 15 15.833334 $395.8400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 10 11.450000 $572.5000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 2.200000 $110.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 7 7.183334 $179.5900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 8.027778 $401.3900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 5 5 3.826191 $95.6600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 0.650000 $32.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 4.683334 $117.0900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 28.428572 $710.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 224 245 1491.914274 $74595.7500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 8.428571 $421.4300 $50.0000
INTR -T1013 INTERPRETER 23 30 123.892856 $6194.6500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 739 857 4939.961087 $49399.6500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 3.990476 $287.1500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.011111 $0.8000 $71.8900
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.714286 $98.7400 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 5 5 16.500001 $1187.3300 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 1.714286 $98.6800 $57.5600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 1 2 0.666667 $12.0900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 19 87.214284 $6275.9300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 4 14.285713 $1028.0000 $71.9600
TRAV -TRAVS Travel by mile 2 2 6.285714 $2.8000 $0.4400
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Subtotal (Total Children Is Unduplicated) 827 1698 7062.400186 $154287.3400 $21.8500
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Total 1756 7125.206535 $154802.4200 $21.7300
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Number of Children (Unduplicated) With at Least One Authorization 871