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 1272 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 239 239 250.857143 $5892.6300 $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
OCTH -97167 OT EVAL HIGH COMPLEXITY 18 18 17.011111 $868.4200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $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 15 15 20.571429 $916.4600 $44.5500
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Subtotal (Total Children Is Unduplicated) 277 281 297.439683 $8097.6800 $27.2200
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 205 210 168.880954 $8444.0500 $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 280 310 2652.771436 $132638.5600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 9 56.142858 $4010.8300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 53 59 319.714286 $18287.6700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 56 59 344.428574 $24605.9700 $71.4400
SENS -V5264 EARMOLD 4 4 4.000000 $72.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 95 97 600.361907 $42889.8800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 4.357143 $60.4800 $13.8800
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Subtotal (Total Children Is Unduplicated) 563 991 4409.450010 $244090.9900 $55.3600
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Total 1272 4706.889693 $252188.6600 $53.5800
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Number of Children (Unduplicated) With at Least One Authorization 755