Summary Report for FSPSAs Ending During the Report Period Center: 52
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 731 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 5 5 3.500000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 3.500000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 7 7 7.000000 $350.0000 $50.0000
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
SCREEN-T1023 SCREENING 5 5 5.000000 $250.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 3.000000 $146.8200 $48.9400
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Subtotal (Total Children Is Unduplicated) 18 18 19.000000 $949.9700 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 8.000000 $400.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 10 10 16.600000 $830.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.133333 $3.3300 $24.9900
CONIF -CONIF CONSULT, ITDS FACE TO FACE 183 231 541.300004 $27065.0200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 3.533333 $88.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 132 173 423.804766 $21190.2600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 69 77 201.666670 $10083.3500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 142 153 361.471427 $18073.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.066667 $1.6700 $25.0100
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 18 70.900000 $3545.0200 $50.0000
INTR -T1013 INTERPRETER 8 8 82.023811 $4101.1900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 6 28.819048 $2058.8300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 2 9.714285 $555.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 4 6 29.985714 $2142.1900 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 16 89.733334 $6410.5500 $71.4400
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Subtotal (Total Children Is Unduplicated) 258 708 1868.752392 $96613.9400 $51.7000
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Total 731 1891.252392 $97563.9100 $51.5900
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Number of Children (Unduplicated) With at Least One Authorization 271