Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2236 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 23 24 10.155553 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 23 24 10.155553 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 31 51 25.473365 $1235.4700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.477778 $37.4000 $25.3100
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 0.589041 $67.7400 $114.9900
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 3.000000 $153.1500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 50 59 31.203808 $1592.9700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 6 1.022222 $52.1800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 49 58 34.376334 $1754.9200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 10.428571 $532.3800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 110 120 70.518648 $3599.9900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 208 306 180.089767 $9128.3000 $50.6900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 27 34 18.634475 $93172.5000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 305 350 642.966663 $32148.3200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 177 200 323.291272 $16164.5900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 149 173 258.479365 $12923.9700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 359 406 619.262707 $30963.1800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 350 391 1847.584124 $92379.2800 $50.0000
INTR -T1013 INTERPRETER 23 26 140.224605 $7011.2400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 68 76 450.366667 $32174.1800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 3.066667 $175.4200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 74 93 483.995234 $34576.6100 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 5 5 1.116590 $20.1000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 129 144 907.290476 $64816.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 25.428571 $352.9500 $13.8800
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Subtotal (Total Children Is Unduplicated) 610 1906 5722.707416 $417107.1600 $72.8900
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Total 2236 5912.952736 $426235.4500 $72.0900
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Number of Children (Unduplicated) With at Least One Authorization 652