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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 7332 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 31 34 65.378570 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 31 34 65.378570 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 261 423 457.319041 $22179.9500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 13 15 13.316667 $747.0700 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.450000 $7.1300 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.305556 $25.4700 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.650000 $15.3900 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.305556 $19.1700 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 10 12 16.544443 $365.1300 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.305556 $11.5000 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.305556 $37.7600 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 4.650000 $209.6200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 3 6.427777 $88.7700 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 4.755556 $100.0600 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 1.450000 $126.0600 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 8 10.194444 $462.0100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.955556 $110.6700 $115.8200
EXIT -EXIT EXIT ASSESSMENT 4 4 6.000000 $300.0000 $50.0000
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 292 489 528.935708 $24855.7500 $46.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 63 76 130.483334 $652417.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 9 9 34.269047 $1713.4500 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 6 7 8.261111 $1913.4400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 621 983 896.604375 $44830.2600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 82 119 92.983336 $4649.1800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 148 194 486.068253 $24303.4100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 22 25 58.444443 $2922.2200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 3.455556 $86.3900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 345 435 882.203169 $44110.1200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 33 33 50.716668 $2535.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 11 12 37.543649 $938.5900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 179 243 513.562692 $25678.1000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 17 18 16.351588 $817.5800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 481 639 1239.453965 $61972.6800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 39 42 35.484130 $1774.2300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 13 13.372223 $334.3100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 11 12 105.703175 $5285.1700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 101 135 1712.815082 $85640.7500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 24 27 244.065081 $12203.2600 $50.0000
INTR -T1013 INTERPRETER 1 2 25.571429 $1278.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1357 3609 28810.384883 $345724.5600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 27 36 298.620633 $21488.7300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 32.666666 $2350.6900 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 4 4 35.650794 $2565.4200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 40.516667 $2915.5800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 24 33 397.543649 $28607.2500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 40.000000 $2878.4000 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 4 4 78.000000 $5612.8700 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 3 4 29.156348 $2098.0900 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 7 10.288889 $4724.8700 $459.2200
SENS -V5264 EARMOLD 7 10 19.099999 $346.2800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 36 56 684.588891 $49263.0400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 6 37.833334 $2722.4900 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 36.733334 $2643.3400 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.033333 $2.4000 $71.8900
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Subtotal (Total Children Is Unduplicated) 1444 6809 37138.529726 $1449348.5200 $39.0300
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Total 7332 37732.844004 $1474204.2700 $39.0700
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Number of Children (Unduplicated) With at Least One Authorization 1461