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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1693 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 77 78 42.626188 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 77 78 42.626188 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 29 33 23.019636 $1116.4600 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 1.221917 $140.5200 $115.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 37 39 17.788888 $908.1200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.322222 $16.4500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 59 68 31.457026 $1605.9000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 53 55 28.083865 $1433.6700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.122222 $6.2400 $51.0400
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Subtotal (Total Children Is Unduplicated) 154 203 103.015776 $5255.1800 $51.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 28 29 20.110960 $100555.5000 $5000.0300
CONIF -CONIF CONSULT, ITDS FACE TO FACE 243 258 316.738102 $15836.9400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 140 157 172.716672 $8635.8600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 95 103 106.249206 $5312.4600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 259 280 266.546831 $13327.3700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 342 375 1794.684112 $89734.2500 $50.0000
INTR -T1013 INTERPRETER 2 2 5.352381 $267.6200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 43 46 217.857936 $15563.7800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 68 86 342.746031 $24485.7800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 2.266667 $129.5600 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 1.221917 $278.5900 $228.0000
SENS -V5264 EARMOLD 5 5 1.221917 $21.9900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 59 65 325.737300 $23270.6900 $71.4400
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Subtotal (Total Children Is Unduplicated) 538 1412 3573.450032 $297420.4100 $83.2300
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Total 1693 3719.091996 $302675.5900 $81.3800
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Number of Children (Unduplicated) With at Least One Authorization 613