Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1968 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 88 94 58.005175 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 88 94 58.005175 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 37 44 29.421765 $1426.9600 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 5 15.714286 $437.3300 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 1.430137 $164.4600 $115.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 44 47 24.661874 $1259.0000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 74 84 45.837289 $2339.9800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 64 72 36.664916 $1871.7400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.050000 $2.5500 $51.0500
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Subtotal (Total Children Is Unduplicated) 189 260 153.780267 $7502.0200 $48.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 34 37 27.464610 $137322.5000 $4999.9800
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.087671 $250.1700 $230.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 298 319 401.514283 $20075.7000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 145 166 201.834129 $10091.7200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 131 144 164.494449 $8224.7500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 313 338 360.787304 $18039.3700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 342 368 1756.684110 $87834.2300 $50.0000
INTR -T1013 INTERPRETER 1 1 13.800000 $690.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 49 52 320.971428 $22930.1900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 78 94 445.071427 $31795.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.466667 $198.1600 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 9 9 1.736986 $396.0400 $228.0000
SENS -V5264 EARMOLD 8 8 1.517808 $27.3200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 66 75 330.861901 $23636.8200 $71.4400
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Subtotal (Total Children Is Unduplicated) 565 1614 4031.292773 $361512.8800 $89.6800
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Total 1968 4243.078215 $369014.9000 $86.9700
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Number of Children (Unduplicated) With at Least One Authorization 656