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: 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 2949 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
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 347 347 361.492064 $8491.4500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
EXIT -EXIT EXIT ASSESSMENT 2 2 2.000000 $100.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 58 60 59.011111 $3012.5200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 10 9.411111 $480.4400 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 4.000000 $204.2000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 4 4 4.000000 $204.2000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 81 84 99.998413 $4454.9200 $44.5500
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Subtotal (Total Children Is Unduplicated) 480 518 546.912699 $17267.8900 $31.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 205 211 169.547621 $8477.3900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 32 33 22.633331 $1131.6600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 89 91 149.784922 $7489.2500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 111 115 83.852377 $4192.5900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.522222 $38.0600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 828 911 7081.304776 $354065.1900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 19.666667 $983.3400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 54 57 289.071429 $20651.2500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 234 251 1433.704767 $82007.8900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 329 345 1648.647619 $117779.4100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 33.857143 $1935.2800 $57.1600
SENS -V5264 EARMOLD 6 6 6.000000 $108.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 359 377 2243.634924 $160285.2500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 16.285714 $931.5400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 0.285714 $20.4100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 12 13 81.571429 $1132.2100 $13.8800
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Subtotal (Total Children Is Unduplicated) 1307 2431 13286.370655 $776688.7100 $58.4600
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Total 2949 13833.283354 $793956.6000 $57.3900
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Number of Children (Unduplicated) With at Least One Authorization 1352