Summary Report for FSPSAs Ending During the Report Period Center: 04
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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2702 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 9 10 10.828571 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 10 10.828571 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 10 4.088889 $198.3100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.427778 $21.8400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 157 163 75.752383 $3867.1800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 123 133 38.563492 $1968.6700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.355556 $18.1500 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 95 98 33.336509 $1701.8300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.183334 $8.9800 $48.9600
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Subtotal (Total Children Is Unduplicated) 299 409 153.707941 $7841.4400 $51.0200
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 27 85 15.883335 $794.1800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 7 7.555556 $377.7800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 1.314286 $65.7200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 8 7.627778 $381.3900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 119 141 784.714273 $19617.8800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 688 751 5410.857122 $270542.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 683 791 5702.140462 $57021.4000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 164 173 959.510313 $68547.4400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 31 34 104.499997 $5977.4200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 128 132 756.785706 $54064.7800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 17 18 45.499999 $2600.7900 $57.1600
RSPT -RSPT RESPITE 1 1 9.428571 $0.0000 $0.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 96 100 505.714282 $36128.2700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 34 37 133.857146 $1857.9400 $13.8800
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Subtotal (Total Children Is Unduplicated) 891 2283 14448.388826 $518681.8100 $35.9000
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Total 2702 14612.925338 $526523.2500 $36.0300
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Number of Children (Unduplicated) With at Least One Authorization 903