Summary Report for FSPSAs Ending During the Report Period Center: 09
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 2473 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 23 25 36.512698 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 23 25 36.512698 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.361111 $26.5600 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 1.772222 $41.9500 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.772222 $26.0200 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.772222 $12.7600 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 1.772222 $51.2500 $28.9200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $13.8100 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 0.772222 $16.2500 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 2 2 1.361111 $83.0300 $61.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.411111 $18.6300 $45.3200
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 15 80.852381 $4042.6300 $50.0000
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Subtotal (Total Children Is Unduplicated) 17 35 92.846824 $4332.8700 $46.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 2.555556 $12778.0000 $5000.0900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 188 275 364.444264 $18222.2100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 172 239 259.818956 $6495.4700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 78 80 75.996707 $3799.8500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.488889 $12.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 64 65 57.157936 $2857.9000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 37 37 35.694325 $1784.7200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 72 72 94.900002 $4745.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 0.488889 $12.2200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 2.714286 $135.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 807 930 5904.766663 $295238.4500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 8.142857 $407.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 147 166 1012.988093 $72894.6700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 16.000000 $1151.3600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 136 153 975.822615 $70220.2700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 5.142857 $370.0800 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 1.377778 $158.1900 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.411111 $94.3900 $229.6000
SENS -V5264 EARMOLD 3 3 1.772222 $32.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 327 371 2503.288088 $180136.7200 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 25.714285 $1850.4100 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 3.142857 $226.1600 $71.9600
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Subtotal (Total Children Is Unduplicated) 1107 2413 11353.829236 $673648.2800 $59.3300
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Total 2473 11483.188758 $677981.1500 $59.0400
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Number of Children (Unduplicated) With at Least One Authorization 1126