Summary Report for FSPSAs Ending During the Report Period Center: 54
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 1578 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 7 7 5.900000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 9.666666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 15.566666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 85 102 81.605555 $3957.8700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.2000 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.8400 $15.8400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.083333 $1.9700 $23.6600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.083333 $15.9000 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 4.894444 $108.0200 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.083333 $0.7300 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.083333 $2.4100 $28.9100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.083333 $48.8400 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.283333 $3.9100 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.083333 $1.7500 $21.0300
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.288889 $58.4100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.083333 $9.6500 $115.7600
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Subtotal (Total Children Is Unduplicated) 93 123 93.655552 $4337.5000 $46.3100
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 1.761111 $74.6900 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 20 22 32.088887 $160443.5000 $4999.9700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 196 245 185.153176 $9257.6800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 13 16 10.561111 $528.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 50 54 44.162701 $2208.1500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 86 88 60.711108 $3035.5400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 4.363491 $218.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.666667 $16.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 71 72 55.266665 $2763.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 163 172 111.715869 $5585.7800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 3 0.266666 $13.3300 $49.9900
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.033334 $25.8400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 5.466667 $273.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 61 65 310.844448 $15542.2200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 3.000000 $150.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 365 656 1760.523808 $21126.2900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 10 63.022223 $4535.0800 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 3 14.000000 $1007.4400 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 5 5 17.268255 $1242.6300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 4 4 19.012699 $1368.1500 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 3 3 11.628571 $836.7900 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.083333 $38.2500 $459.0400
SENS -V5264 EARMOLD 2 2 2.083333 $37.7700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 12 50.179363 $3610.9100 $71.9600
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Subtotal (Total Children Is Unduplicated) 506 1446 2765.863486 $233964.5900 $84.5900
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Total 1578 2875.085704 $238302.1000 $82.8900
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Number of Children (Unduplicated) With at Least One Authorization 516