Summary Report for FSPSAs Ending During the Report Period Center: 54
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 1755 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 7 7 3.266666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 7 3.266666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 76 103 76.097624 $3690.7600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 2.622222 $147.1100 $56.1000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 4.055556 $89.5100 $22.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.800000 $24.8600 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.150000 $3.1600 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.138889 $96.9400 $45.3200
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Subtotal (Total Children Is Unduplicated) 84 116 86.864291 $4052.3200 $46.6500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 19 35.377778 $176889.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.855556 $429.7900 $231.6300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 205 252 201.397222 $10069.8600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 20 30 24.672222 $1233.6100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 41 47 69.879369 $3493.9900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.566667 $14.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 99 101 76.891270 $3844.5600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 2.166667 $108.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 62 52.099210 $2604.9800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 1.533333 $76.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 157 163 130.905556 $6545.2800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 1.227777 $61.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.033333 $0.8300 $24.9800
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 0.714286 $35.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 29 29 137.004763 $6850.2500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 12.785714 $639.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 489 879 2751.627787 $27516.2800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 29.614286 $2131.0500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.266667 $91.1500 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 1.155556 $83.1600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 3.733333 $268.6500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 14 14 68.038889 $4896.0700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 3.142857 $226.1600 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 1.911111 $877.6200 $459.2200
SENS -V5264 EARMOLD 3 3 3.155555 $57.2100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 8 49.904761 $3591.1600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.700000 $122.3300 $71.9600
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Subtotal (Total Children Is Unduplicated) 525 1632 3664.361525 $252758.5200 $68.9800
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Total 1755 3754.492482 $256810.8400 $68.4000
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Number of Children (Unduplicated) With at Least One Authorization 533