Summary Report for FSPSAs Ending During the Report Period Center: 07
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 1048 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 37 38 32.494444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 37 38 32.494444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 2.000000 $39.4200 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 2.000000 $46.9800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 2.000000 $27.7400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 2.000000 $47.4000 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 2.000000 $169.6800 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 3.571429 $59.6400 $16.7000
EXIT -EXIT EXIT ASSESSMENT 79 80 83.138835 $4156.9600 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.052055 $3.9100 $75.0600
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.052055 $2.8900 $55.5500
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 0.142466 $7.9100 $55.5100
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.071233 $5.3400 $74.9700
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.322222 $16.4500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.377778 $19.2900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 6.476191 $330.6100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.794444 $38.8800 $48.9400
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Subtotal (Total Children Is Unduplicated) 104 112 112.998708 $5381.4800 $47.6200
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 7 3.739727 $186.9900 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 142 166 113.899340 $5695.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 7 5.716667 $142.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 202 257 565.009522 $28250.4700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 1.799999 $45.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 46 48 107.923810 $5396.1900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 12.252381 $306.3100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 31 32 74.066667 $3703.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 1.933333 $48.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 99 108 198.828574 $9941.4400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 21.557143 $538.9300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 194 210 1543.762690 $77188.1900 $50.0000
INTR -T1013 INTERPRETER 4 4 43.442857 $2172.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 10 54.857143 $3918.9900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 5 28.714284 $2051.3600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 25 29 225.214285 $16089.3100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 3.428571 $47.5900 $13.8800
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Subtotal (Total Children Is Unduplicated) 421 898 3007.146993 $155772.5300 $51.8000
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Total 1048 3152.640145 $161154.0100 $51.1200
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Number of Children (Unduplicated) With at Least One Authorization 516