Summary Report for FSPSAs Initiated During the Report Period Center: 06
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: 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 2719 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 43 43 47.241271 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 43 43 47.241271 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.333333 $154.4100 $115.8100
EXIT -EXIT EXIT ASSESSMENT 6 6 12.000000 $600.0000 $50.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 26 26 16.099998 $2289.8700 $142.2300
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Subtotal (Total Children Is Unduplicated) 32 34 29.433331 $3044.2800 $103.4300
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 276 281 152.622531 $7631.2100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 19 19 9.766668 $488.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 156 161 77.765586 $1944.1500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 16 17 23.922221 $1196.1100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 4 4 3.216667 $160.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 17 19 27.002382 $675.0600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 9 14.966666 $748.3300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 3.166667 $158.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 9 9 12.733334 $318.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 3.016666 $150.8300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 2 2 2.100000 $105.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 6 6 4.092858 $102.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 3 1.833334 $91.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 10.485714 $262.1400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 15 15 397.428572 $9935.7100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 11 349.142859 $8728.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 720 786 4409.738092 $220487.1600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 19 19 111.009525 $5550.4900 $50.0000
INTR -T1013 INTERPRETER 24 32 168.178571 $8408.9300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 801 921 5247.490473 $52474.9600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 58 62 237.892061 $17118.7000 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 5 6 23.607144 $1698.7700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 21 23 144.061903 $8297.9600 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 4 4 14.571429 $839.3100 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 50 54 285.432141 $20539.7100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 6 15.535714 $1117.9400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 14 16 62.021431 $3569.9500 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 4 17.500000 $1007.3000 $57.5600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 17 17 11.544445 $209.3000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 87 102 542.725395 $39054.5300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 13 16 60.178571 $4330.4500 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.428571 $82.2900 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 1.142857 $65.8300 $57.6000
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 18.928571 $264.2400 $13.9600
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Subtotal (Total Children Is Unduplicated) 1053 2642 12469.249619 $418735.2300 $33.5800
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Total 2719 12545.924221 $421779.5100 $33.6200
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Number of Children (Unduplicated) With at Least One Authorization 1092