Summary Report for FSPSAs Initiated During the Report Period Center: 09
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 517 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 25 25 30.907937 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 25 25 30.907937 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.138889 $2.7100 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.138889 $3.2900 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.138889 $2.0400 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.138889 $1.0000 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.138889 $4.0200 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.138889 $2.9200 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.138889 $8.4700 $61.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 2.428571 $121.4300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 13.457142 $672.8600 $50.0000
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Subtotal (Total Children Is Unduplicated) 6 12 16.857936 $818.7400 $48.5700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 90 142 215.304110 $10765.2100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 27 32 27.755480 $693.8900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 56 59 51.327779 $2566.4000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 34 34 31.738888 $1586.9400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 21 21 16.961111 $848.0600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 48 48 43.922222 $2196.1100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 83 93 582.309527 $29115.5000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 15 68.319047 $4916.2400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 6 7 40.714284 $2929.8100 $71.9600
SENS -V5264 EARMOLD 1 1 0.138889 $2.5200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 26 28 153.178572 $11022.7500 $71.9600
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Subtotal (Total Children Is Unduplicated) 235 480 1231.669909 $66643.4000 $54.1100
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Total 517 1279.435782 $67462.1400 $52.7300
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Number of Children (Unduplicated) With at Least One Authorization 262