Summary Report for FSPSAs Ending During the Report Period Center: 10
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 2313 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 3 3 1.022222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 1.022222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 390 391 432.873015 $10168.1800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
OCTH -97167 OT EVAL HIGH COMPLEXITY 16 16 20.879365 $1065.8900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 12 12 41.857142 $2048.4900 $48.9400
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Subtotal (Total Children Is Unduplicated) 421 426 502.609522 $13602.7300 $27.0600
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 170 175 120.803178 $6040.1800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 11 5.911112 $295.5600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 48 48 33.311110 $1665.5500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 76 78 44.677778 $2233.8900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 835 867 6212.413889 $310620.6700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 94 97 464.309533 $33170.2100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 98 104 392.535712 $22453.0400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 260 268 1134.713493 $81063.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 9.000000 $514.4400 $57.1600
SENS -V5264 EARMOLD 7 7 7.000000 $126.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 203 216 1020.801586 $72926.0600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 70.571429 $979.5300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1208 1884 9518.048820 $532549.0500 $55.9500
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Total 2313 10021.680564 $546151.7900 $54.5000
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Number of Children (Unduplicated) With at Least One Authorization 1280