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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1494 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 70 71 50.046827 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 70 71 50.046827 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 25 30 22.973895 $1114.2300 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.126027 $14.4900 $114.9800
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 0.492542 $25.1500 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 2.884932 $147.2700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 13 7.550000 $385.4300 $51.0500
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Subtotal (Total Children Is Unduplicated) 44 52 34.027396 $1686.5700 $49.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 4 2.166667 $10833.5000 $5000.0800
CONIF -CONIF CONSULT, ITDS FACE TO FACE 352 410 516.076182 $25803.7700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 169 182 213.933331 $10696.6600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 146 170 199.991271 $9999.5700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 352 384 450.872213 $22543.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 155 179 872.217454 $43610.9000 $50.0000
INTR -T1013 INTERPRETER 4 4 27.069842 $1353.5000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 21.504761 $1536.3000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 11 13 71.784126 $5128.2700 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.126027 $28.7300 $227.9500
SENS -V5264 EARMOLD 1 1 0.126027 $2.2700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 19 128.557143 $9184.1200 $71.4400
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Subtotal (Total Children Is Unduplicated) 531 1371 2504.425044 $140721.1400 $56.1900
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Total 1494 2588.499267 $142407.7100 $55.0200
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Number of Children (Unduplicated) With at Least One Authorization 600