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 1969 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
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 80 102 82.604758 $4006.3100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 3.194445 $179.2100 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.283333 $4.4900 $15.8400
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 8.444444 $186.3700 $22.0700
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.283333 $24.6300 $86.9300
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.661111 $29.9600 $45.3200
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 91 116 97.471424 $4530.9700 $46.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 23 25.538889 $127694.5000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.444444 $102.9300 $231.6000
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 187 200 142.200794 $7110.0400 $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 3 3 18.044444 $902.2200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 36 36 174.222220 $8711.1100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 18.000001 $900.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 536 999 2958.385698 $29583.8700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 23.952381 $1723.6100 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 3 3 29.714287 $2138.2300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 13 13 54.795239 $3943.0700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.755556 $198.2900 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.888889 $408.2000 $459.2300
SENS -V5264 EARMOLD 2 2 2.644445 $47.9400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 8 42.701586 $3072.8100 $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 1 1 1.266667 $91.1500 $71.9600
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Subtotal (Total Children Is Unduplicated) 555 1848 3924.323001 $207990.4600 $53.0000
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Total 1969 4026.305536 $212521.4300 $52.7800
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Number of Children (Unduplicated) With at Least One Authorization 557