Summary Report for FSPSAs Ending During the Report Period Center: 52
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 621 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 2 2 0.888889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 0.888889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.766667 $25.9400 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.766667 $15.5600 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.766667 $51.0900 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.766667 $37.1700 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.145206 $6.5800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.145206 $16.8200 $115.8100
SCREEN-T1023 SCREENING 6 6 6.000000 $300.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 9 19 14.357080 $504.5700 $35.1400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 2.666667 $133.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 188 233 633.652375 $31682.5900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 119 129 374.152376 $18707.6000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 73 87 248.966663 $12448.3200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 118 120 329.699993 $16484.9700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.466667 $123.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 6.457143 $161.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10 10 45.171428 $2258.5700 $50.0000
INTR -T1013 INTERPRETER 1 1 0.700000 $35.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 9.714286 $699.0400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 4 4 8.169047 $587.8400 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 2 2 0.588889 $10.6800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 10.466666 $753.1800 $71.9600
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Subtotal (Total Children Is Unduplicated) 255 600 1673.872200 $84545.0900 $50.5100
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Total 621 1689.118169 $85049.6600 $50.3500
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Number of Children (Unduplicated) With at Least One Authorization 262