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 2321 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 80 80 80.000000 $1708.0000 $21.3500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 19 20 20.000000 $1021.0000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 22 22.000000 $1123.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 113 125 125.000000 $4005.2500 $32.0400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.116667 $583.5000 $5001.4100
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 362 468 3436.757947 $171837.8200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 71 81 379.280954 $27095.8300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.428571 $253.3200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 78 82 384.877776 $27495.6700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 127 139 745.821430 $53281.4700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 7.714286 $107.0700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1027 2189 5874.582525 $326433.7800 $55.5700
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Total 2321 6003.938081 $330439.0300 $55.0400
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Number of Children (Unduplicated) With at Least One Authorization 1048