Summary Report for FSPSAs Ending During the Report Period Center: 07
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 1792 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 26 26 12.134921 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 26 26 12.134921 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 7.000000 $392.7000 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 13.714286 $267.5700 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 2.000000 $47.3400 $23.6700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.022222 $0.4900 $22.0500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.044444 $0.3200 $7.1900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.066666 $1.9300 $28.8900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 3.066666 $42.3500 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 2 2.000000 $42.0800 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
EXIT -EXIT EXIT ASSESSMENT 8 8 9.000000 $450.0000 $50.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 6 7 4.700000 $241.6300 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.072222 $3.7100 $51.3900
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 2.344444 $120.5300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 2.344444 $120.5300 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.400000 $20.5600 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.327778 $16.8500 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 2.344444 $120.5300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 8 8 7.177778 $369.0100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.238889 $12.2800 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 13.347619 $686.2000 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.177778 $60.5500 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.155556 $51.8400 $44.8600
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Subtotal (Total Children Is Unduplicated) 67 81 79.545236 $3542.5300 $44.5300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.000000 $100.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 198 289 192.539498 $9627.1400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 8.941667 $223.5400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 427 479 975.877560 $48793.8900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 2.766667 $138.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.333333 $33.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 210 223 368.102383 $18405.1300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 98 104 240.433332 $12021.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.466667 $61.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 240 260 419.333329 $20966.6500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 4.166666 $104.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 25 26 205.561906 $10278.1100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 184 195 1271.357143 $63567.8800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 26 26 185.419048 $9270.9500 $50.0000
INTR -T1013 INTERPRETER 2 2 2.171429 $108.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 2 2.714285 $27.1400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 16 89.428573 $6435.2800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 9 9 45.999999 $3310.1700 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 8.000000 $460.4800 $57.5600
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 30 32 240.161904 $17282.0600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 3.142857 $226.1600 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.571429 $148.1100 $57.6000
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Subtotal (Total Children Is Unduplicated) 649 1685 4278.489675 $226727.8900 $52.9900
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Total 1792 4370.169832 $230270.4200 $52.6900
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Number of Children (Unduplicated) With at Least One Authorization 680