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: 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 1850 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
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 307 307 324.857142 $7630.9000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $27.7400 $13.8700
OCTH -97167 OT EVAL HIGH COMPLEXITY 8 8 7.233333 $369.2600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 4.285714 $209.7400 $48.9400
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Subtotal (Total Children Is Unduplicated) 320 322 339.376189 $8288.6900 $24.4200
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 135 138 114.827780 $5741.4000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 4.499999 $225.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 33 25.600001 $1280.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 36 36 23.622223 $1181.1200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 740 754 6265.194851 $313259.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 71 71 355.498415 $25396.7600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 67 68 352.571439 $20167.0400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 225 231 1034.698342 $73918.7000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 9.283333 $530.6300 $57.1600
SENS -V5264 EARMOLD 2 2 2.000000 $36.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 180 181 987.658738 $70558.3200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 11.142857 $637.3700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 10.214287 $141.7700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1118 1528 9197.812265 $513303.9800 $55.8100
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Total 1850 9537.188454 $521592.6700 $54.6900
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Number of Children (Unduplicated) With at Least One Authorization 1160