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 736 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 118 118 121.285714 $2849.0000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $97.8800 $48.9400
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Subtotal (Total Children Is Unduplicated) 122 123 126.285714 $3062.8500 $24.2500
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 230 233 1970.419049 $98521.0200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 21 21 113.569842 $8113.4200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 22 22 132.642859 $7587.1600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 56 58 311.030953 $22220.0300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 66 66 378.256353 $27022.6200 $71.4400
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Subtotal (Total Children Is Unduplicated) 472 613 3075.469059 $172121.7500 $55.9700
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Total 736 3201.754773 $175184.6000 $54.7200
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Number of Children (Unduplicated) With at Least One Authorization 561