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: 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 2353 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 32 32 72.019049 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 32 32 72.019049 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 2.233333 $125.2900 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.488889 $9.5400 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.488889 $11.5700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.488889 $7.1800 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.488889 $4.3100 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.488889 $14.1400 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.488889 $10.2900 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.488889 $42.5100 $86.9400
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 8.428572 $421.4300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 17 17 81.761906 $4088.1100 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 26 27 186.066671 $9565.6700 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 4.428571 $227.6700 $51.4100
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Subtotal (Total Children Is Unduplicated) 47 55 286.341276 $14527.7000 $50.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 201 284 375.563789 $18778.2100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 147 204 211.602082 $5290.0500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 122 124 122.687304 $6134.3700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 62 63 62.138096 $3106.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 37 37 45.099207 $2254.9600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 -1.016667 $-25.4200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 84 84 77.638891 $3881.9600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 913 1002 7106.038171 $355301.6500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 112 123 740.747626 $53304.1500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 99 107 774.452388 $55729.5700 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.488889 $56.1300 $114.8100
SENS -V5264 EARMOLD 1 1 0.488889 $8.8600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 216 233 1750.326208 $125953.3900 $71.9600
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Subtotal (Total Children Is Unduplicated) 1102 2266 11268.254873 $634799.7900 $56.3400
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Total 2353 11626.615198 $649327.4900 $55.8500
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Number of Children (Unduplicated) With at Least One Authorization 1134