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 1497 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 25 44 22.391554 $1086.0000 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.035616 $4.0900 $114.9500
OCTH -97167 OT EVAL HIGH COMPLEXITY 13 15 7.833334 $399.9000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 4.868570 $248.5400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 26 28 19.264916 $983.4700 $51.0500
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Subtotal (Total Children Is Unduplicated) 65 98 55.393990 $2773.0500 $50.0600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 4.172222 $20861.0000 $4999.9700
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 148 172 257.812698 $12890.6300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 358 405 616.429374 $30821.5100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 124 137 649.423805 $32471.2300 $50.0000
INTR -T1013 INTERPRETER 23 26 140.224605 $7011.2400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 17 124.999999 $8930.0000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 14 15 70.371428 $5027.3400 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.035616 $8.1200 $227.9000
SENS -V5264 EARMOLD 1 1 0.035616 $0.6400 $17.9900
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 41 46 384.276191 $27452.7000 $71.4400
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Subtotal (Total Children Is Unduplicated) 515 1375 3214.039489 $193787.3100 $60.2900
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Total 1497 3279.589032 $196560.3600 $59.9300
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Number of Children (Unduplicated) With at Least One Authorization 546