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 2035 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 -92553 PURE TONE AUDIOMETRY AIR & BONE 63 63 25.022222 $480.4300 $19.2000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 18 18 14.577778 $744.2000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 1.177778 $60.1300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 30 30 23.455555 $1197.4000 $51.0500
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Subtotal (Total Children Is Unduplicated) 105 113 64.233333 $2482.1500 $38.6400
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 293 342 2491.495246 $124574.7600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 70 76 423.546032 $30258.1300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.142857 $294.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 75 82 405.357141 $28958.7100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 128 138 800.988095 $57222.5800 $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) 883 1911 4760.513108 $274701.0100 $57.7000
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Total 2035 4831.135330 $277183.1600 $57.3700
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Number of Children (Unduplicated) With at Least One Authorization 914