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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2167 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 19 21 9.000000 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 19 21 9.000000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 81 84 82.411112 $1759.4800 $21.3500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 17 17.000000 $867.8500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 17 17 17.000000 $867.8500 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 113 120 118.411112 $3597.2800 $30.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 573 638 463.874600 $23193.7200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 0.822223 $20.5600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 76 83 54.244441 $2712.2100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 126 130 95.614286 $4780.7100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 413 441 268.326989 $13416.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 0.822223 $20.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 353 435 3077.265083 $153863.1900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 61 69 357.071428 $25509.1700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 79 82 447.197621 $31947.7700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 5.714286 $326.6300 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 119 134 782.000002 $55866.0500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 9.142857 $126.9000 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 947 2026 5565.096039 $317243.8300 $57.0100
-------------------------------------------------------------------------------------------------------------------------------------
Total 2167 5692.507151 $320841.1100 $56.3600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 999