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 1328 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 31 34 22.871764 $1109.2800 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 1.405556 $71.7600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 15 10.838736 $553.3200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 14 15 7.027854 $358.7700 $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) 57 70 43.193910 $2123.5000 $49.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 11 8.157610 $40788.0000 $4999.9900
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 130 142 640.882530 $32044.1400 $50.0000
INTR -T1013 INTERPRETER 1 1 13.800000 $690.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 19.600000 $1400.2200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 18 21 106.480953 $7607.0000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 18 78.623808 $5616.8900 $71.4400
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Subtotal (Total Children Is Unduplicated) 461 1164 1996.175066 $144577.7900 $72.4300
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Total 1328 2097.374151 $146701.2900 $69.9500
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Number of Children (Unduplicated) With at Least One Authorization 556