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: 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 2927 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 41 42 21.703172 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 41 42 21.703172 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 8 2.527778 $122.6000 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 130 153 46.060315 $2351.3600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 111 137 36.924609 $1885.0300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.066667 $3.4100 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 52 53 12.177779 $621.6800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.016667 $0.8500 $51.1500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 11 13 2.677777 $131.0500 $48.9400
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Subtotal (Total Children Is Unduplicated) 251 366 100.451592 $5115.9800 $50.9300
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 69 13.977781 $698.9100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 11.019047 $550.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.800000 $40.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.966666 $48.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 2 2.433334 $60.8400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 147 208 1142.428572 $28560.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 690 792 5292.368237 $264618.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 695 858 5664.635703 $56646.3500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 59 59 360.499998 $25754.1300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 128 171 761.603169 $43563.6700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 53 58 307.857139 $21993.3200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 107 135 633.392869 $36204.6900 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 23 122.714286 $8766.7000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 101 135 541.142860 $7511.0500 $13.8800
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Subtotal (Total Children Is Unduplicated) 902 2519 14859.839661 $495385.6600 $33.3400
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Total 2927 14981.994425 $500501.6400 $33.4100
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Number of Children (Unduplicated) With at Least One Authorization 939