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 614 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 22 24 36.168254 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 24 36.168254 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.361111 $7.0500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.361111 $8.5500 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.361111 $5.3000 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.361111 $2.6000 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.361111 $10.4400 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.361111 $7.6000 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.361111 $22.0300 $61.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 12.971429 $648.5700 $50.0000
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Subtotal (Total Children Is Unduplicated) 3 9 15.499206 $712.1300 $45.9500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 90 143 215.348554 $10767.4300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 27 32 28.005480 $700.1400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 55 57 61.724484 $3086.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.488889 $12.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 44 44 41.433334 $2071.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 22 22.449881 $1122.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 47 47 75.916669 $3795.8400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.044444 $1.1100 $24.9800
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 2.714286 $135.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 130 146 840.233330 $42011.7000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 21 106.392859 $7656.0200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 19 20 125.257142 $9013.5100 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.377778 $43.3800 $114.8200
SENS -V5264 EARMOLD 1 1 0.361111 $6.5500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 38 43 291.928570 $21007.1800 $71.9600
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Subtotal (Total Children Is Unduplicated) 315 581 1813.676811 $101456.1700 $55.9400
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Total 614 1865.344271 $102168.3000 $54.7700
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Number of Children (Unduplicated) With at Least One Authorization 335