Summary Report for FSPSAs Initiated During the Report Period Center: 54
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 2568 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 5 5 4.511111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 4.511111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 2.000000 $206.7200 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 82 104 84.604758 $4103.3100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 15 16 16.122222 $904.4600 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 4 4 0.927778 $14.7000 $15.8400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.138889 $16.7200 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 37 37 35.618256 $786.1000 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 0.505556 $3.6400 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.138889 $4.0200 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.366667 $7.7200 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.366667 $22.3700 $61.0100
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 0.650000 $56.5100 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 3 3 6.044445 $454.1200 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 12 6.933333 $314.2200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.366667 $42.4700 $115.8200
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 140 188 157.784127 $7037.0600 $44.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 29 34 37.599999 $187999.5000 $4999.9900
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 2.394444 $554.5900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 209 251 215.658733 $10782.9500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 22 31 25.016666 $1250.8300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 51 61 55.464286 $2773.2200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 1.000000 $50.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.100000 $27.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 114 116 73.199999 $3660.0000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 6 6 3.855555 $192.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 59 64 45.822223 $2291.1200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 2 2 1.877777 $93.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 188 201 143.000794 $7150.0400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 4 4 1.394444 $69.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.077778 $76.9500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 24.758730 $1237.9400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 332 352 1672.326969 $83616.4100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 25 25 98.126191 $4906.3000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 536 999 2958.385698 $29583.8700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 31 31 156.066665 $11230.5600 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 5 6 31.765081 $2285.8200 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 27 28 160.057142 $11517.7100 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 41 41 160.175396 $11526.2300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 3 4.855556 $349.4100 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 19 20 92.951587 $6688.7900 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 4.333333 $311.8200 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.277778 $31.8900 $114.8200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 4 4.511111 $2071.5900 $459.2200
SENS -V5264 EARMOLD 7 7 13.822224 $250.6000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 35 39 181.019838 $13026.2000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.300000 $93.5500 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 27 28 129.721431 $9334.7700 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.266667 $19.1900 $71.9700
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Subtotal (Total Children Is Unduplicated) 562 2375 6306.184095 $405125.0400 $64.2400
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Total 2568 6468.479333 $412162.1000 $63.7200
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Number of Children (Unduplicated) With at Least One Authorization 565