Summary Report for FSPSAs Initiated During the Report Period Center: 10
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start 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 starting 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 4327 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 7 7 4.355556 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 7 4.355556 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 485 488 486.466667 $10386.0600 $21.3500
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 6.000000 $270.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 7.000000 $805.0000 $115.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 47 49 47.588889 $2429.4100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 16 17 16.522222 $843.4600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 55 63 62.688889 $3200.2700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 574 632 628.266667 $18036.3000 $28.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.116667 $15583.5000 $5000.0500
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 657 700 450.830144 $22541.4300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 79 81 52.027779 $2601.4000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 122 125 91.288886 $4564.4300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 499 510 321.438085 $16071.8500 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.011111 $0.2800 $24.9800
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1041 1320 9513.299635 $475664.7900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 245 272 1380.904765 $98651.8200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.428571 $253.3200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 286 303 1338.402362 $95615.5100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.785714 $44.9100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 326 366 1860.607142 $132921.7300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 19.357143 $268.6800 $13.8800
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Subtotal (Total Children Is Unduplicated) 1384 3688 15037.498004 $865013.6400 $57.5200
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Total 4327 15670.120227 $883049.9400 $56.3500
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Number of Children (Unduplicated) With at Least One Authorization 1414