Summary Report for FSPSAs Initiated During the Report Period Center: 54
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: 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 9800 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 29 31 52.946031 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.533333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 30 32 53.479364 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 3 7.000000 $723.5200 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 251 403 422.499205 $20491.2100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 56 66 67.693152 $3797.5900 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 9 10 6.933333 $109.8200 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 2.550000 $49.7500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 4 3.061111 $72.4600 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 7 4.927778 $72.3400 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 93 108 133.751589 $2951.9000 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 6 4.022222 $35.4400 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 4 2.538889 $73.4300 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 3 2.061111 $92.9100 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 6 6.805555 $93.9800 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 11 9.727778 $204.6700 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.872222 $53.2000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 5 5 4.194444 $364.6600 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 3 3 13.105555 $984.6200 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 46 54 52.016665 $2357.3900 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 4 1.900000 $220.0400 $115.8100
EXIT -EXIT EXIT ASSESSMENT 3 3 4.000000 $200.0000 $50.0000
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 416 705 750.660609 $32998.9400 $43.9600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 107 135 209.216665 $1046082.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 26.285714 $1314.2900 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 12 15 16.705554 $3869.3000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 636 984 898.748816 $44937.4700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 71 108 85.588892 $4279.4600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 152 211 445.084913 $22254.2100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 3 3.088889 $154.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 4.900000 $122.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 331 415 782.525394 $39126.2500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 11 13 30.882540 $1544.1300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 3.044444 $76.1100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 196 270 508.234917 $25411.7300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.888889 $144.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 502 700 1227.779366 $61388.9700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 9 9 12.233333 $611.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 8 8.738890 $218.4800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.077778 $1.9500 $25.0100
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 20 22 164.638096 $8231.9100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 896 1367 15450.196013 $772509.8300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 87 117 1364.846826 $68242.3500 $50.0000
INTR -T1013 INTERPRETER 1 1 7.857143 $392.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1402 3818 28435.335664 $341224.0200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 102 136 1568.908728 $112898.7300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 19 23 287.482539 $20687.2300 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 73 100 1205.828568 $86771.4000 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 5 5 54.164285 $3897.6600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 101 145 1581.762691 $113823.6300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 8 9 82.282540 $5921.0500 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 75 106 1069.408731 $76954.6600 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 4 6 70.120634 $5045.8800 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 3 4.855556 $557.4700 $114.8100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 8 11 17.111111 $7857.7600 $459.2200
SENS -V5264 EARMOLD 11 18 67.622222 $1225.9900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 110 160 1690.103175 $121619.8500 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 9 66.504762 $4785.6800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 86 121 1394.379363 $100339.5300 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 60.609523 $4361.4600 $71.9600
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Subtotal (Total Children Is Unduplicated) 1449 9063 58911.043164 $3108956.1400 $52.7700
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Total 9800 59715.183137 $3141955.0800 $52.6200
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Number of Children (Unduplicated) With at Least One Authorization 1472