Summary Report for FSPSAs Initiated During the Report Period Center: 07
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: 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 1110 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 21 21 58.566667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 21 58.566667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 4.000000 $225.9600 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 2.000000 $46.9800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 2.000000 $27.7400 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 3.150000 $28.6000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 3.150000 $87.6600 $27.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 3.150000 $52.6100 $16.7000
EXIT -EXIT EXIT ASSESSMENT 84 85 85.002284 $4250.1200 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.079452 $4.4100 $55.5300
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 6 6 6.065754 $336.6500 $55.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 21.000000 $1072.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.127778 $57.5700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 2.383333 $121.6700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 9.857143 $503.2100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
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Subtotal (Total Children Is Unduplicated) 113 126 149.965744 $7159.5800 $47.7400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.233333 $61.6700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 150 175 133.084699 $6654.3200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 21 23 19.577778 $489.4500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 243 274 615.919072 $30795.9600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 6.527977 $163.2000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 99 106 175.516668 $8775.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.366667 $34.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 37 39 88.742855 $4437.1300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 129 154 257.334920 $12866.7400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.833333 $70.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 136 142 1101.285714 $55064.3000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 18.714286 $935.7100 $50.0000
INTR -T1013 INTERPRETER 3 4 12.652381 $632.6200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 72.142857 $5153.8800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 5 39.223810 $2802.1500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 17 140.857141 $10062.8500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.142857 $10.2100 $71.4600
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Subtotal (Total Children Is Unduplicated) 426 963 2689.156348 $139107.6200 $51.7300
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Total 1110 2897.688759 $146267.2000 $50.4800
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Number of Children (Unduplicated) With at Least One Authorization 508