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: 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 2743 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 1 1 0.300000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.300000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 423 426 444.684128 $10445.6300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
OCTH -97167 OT EVAL HIGH COMPLEXITY 39 41 45.379366 $2316.6200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 12 12 10.911111 $557.0100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 4 4 3.788889 $193.4200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 32 32 30.577778 $1496.4800 $48.9400
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Subtotal (Total Children Is Unduplicated) 491 518 538.341272 $15125.1300 $28.1000
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 195 195 153.961104 $7698.0200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 21 22 12.699999 $635.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 57 56.166668 $2808.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 108 108 57.877775 $2893.8800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 855 937 7249.615884 $362480.7500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 17.142857 $171.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 75 76 364.386508 $26031.7500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 171 180 806.464289 $46129.7200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 310 319 1264.846817 $90360.6700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 27.428571 $1567.8200 $57.1600
SENS -V5264 EARMOLD 4 4 4.000000 $72.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 258 276 1202.596433 $85913.4900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.357143 $249.2300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 43 44 350.816665 $4869.3400 $13.8800
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Subtotal (Total Children Is Unduplicated) 1295 2224 11573.360713 $632111.4100 $54.6200
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Total 2743 12112.001985 $647236.5500 $53.4400
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Number of Children (Unduplicated) With at Least One Authorization 1337