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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2450 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 38 39 69.866667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 38 39 69.866667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.833333 $46.7500 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 0.511110 $9.9700 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 0.511110 $12.1000 $23.6600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 0.511110 $7.5000 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 0.511110 $4.5000 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 0.511110 $14.7800 $28.9100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.455555 $6.2900 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 0.055555 $1.1700 $21.0200
AUDE -92651 AEP HEARING STATUS DETER I&R 3 3 0.088888 $7.7200 $86.8500
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 0.422222 $31.7200 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.033333 $1.5100 $45.2800
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.033333 $3.8600 $115.7000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 4.571429 $228.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 12 39.828571 $1991.4400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 24 25 135.999998 $6991.7600 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 8.714286 $448.0000 $51.4100
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Subtotal (Total Children Is Unduplicated) 45 73 196.592053 $9961.8600 $50.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 5.538888 $27694.0000 $4999.9200
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.033333 $7.7100 $231.3900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 202 288 358.206647 $17910.3500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 144 204 208.090971 $5202.2800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 124 130 98.938889 $4946.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 72 73 75.021429 $3751.0700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 43 33.277775 $1663.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.144444 $3.6100 $24.9900
CONSF -CONSF CONSULT, SLP, FACE TO FACE 75 78 66.321429 $3316.0700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.094444 $2.3600 $24.9900
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 887 992 6225.242851 $311262.3000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 118 132 742.600000 $53437.5300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 111 122 831.063489 $59803.3400 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 0.477777 $54.8400 $114.7900
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.033333 $7.6500 $229.3800
SENS -V5264 EARMOLD 3 3 0.477777 $8.6600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 235 259 1784.395235 $128405.1400 $71.9600
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Subtotal (Total Children Is Unduplicated) 1117 2338 10429.958711 $617477.7100 $59.2000
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Total 2450 10696.417431 $627439.5700 $58.6600
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Number of Children (Unduplicated) With at Least One Authorization 1155