Summary Report for FSPSAs Ending During the Report Period Center: 10
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3798 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 11 11 6.388889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 11 6.388889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.394444 $20.8200 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 365 366 138.627788 $2661.6700 $19.2000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.416667 $15.9900 $38.3700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.305556 $14.3000 $46.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.305556 $36.5500 $119.6200
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 41 43 34.655557 $1769.1700 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 11 12 8.144444 $415.7700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 67 73 58.444445 $2983.5900 $51.0500
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Subtotal (Total Children Is Unduplicated) 449 499 242.294457 $7917.8700 $32.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.322223 $1611.5000 $5001.1900
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.900000 $215.2800 $239.2000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 559 632 249.692074 $12484.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 92 97 53.533331 $2676.6600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 138 145 91.230549 $4561.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 370 394 236.305560 $11815.3000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 943 1147 7534.365888 $376718.2600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 216 234 1152.387303 $82326.5600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.142857 $294.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 259 286 1164.303570 $83177.8200 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.611111 $144.9000 $237.1200
SENS -V5264 EARMOLD 1 1 0.611111 $11.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 310 346 1655.294456 $118254.2000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.000000 $27.7600 $13.8800
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Subtotal (Total Children Is Unduplicated) 1269 3288 12146.700033 $694319.5700 $57.1600
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Total 3798 12395.383379 $702237.4400 $56.6500
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Number of Children (Unduplicated) With at Least One Authorization 1320