Summary Report for FSPSAs Ending During the Report Period Center: 57
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 2695 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 0.355556 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 3.553968 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 10.344446 $382.7500 $37.0000
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Subtotal (Total Children Is Unduplicated) 11 11 14.253970 $382.7500 $26.8500
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.116667 $6.5900 $56.5100
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.233333 $10.5000 $44.9900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.233333 $26.8300 $114.9800
OCTH -97167 OT EVAL HIGH COMPLEXITY 56 60 22.439681 $1145.5400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 31 32 13.433332 $685.7600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 75 81 30.019383 $1532.4900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.622223 $27.7200 $44.5600
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Subtotal (Total Children Is Unduplicated) 114 179 68.097952 $3486.4900 $51.2000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 6 11 3.377776 $168.8800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 198 205 109.369044 $5468.4400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 24 25 19.961111 $998.0600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 395 421 180.500804 $9025.1000 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 65 72 385.839680 $9645.9900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 717 768 4636.334108 $231816.7000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 718 771 4638.686488 $46386.8700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 72 78 221.448413 $15820.3000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.714286 $326.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 44 45 182.067462 $13006.9000 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.057534 $26.2200 $455.7300
SENS -V5264 EARMOLD 1 1 0.233333 $4.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 99 106 420.228572 $30021.1300 $71.4400
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Subtotal (Total Children Is Unduplicated) 797 2505 10803.818611 $362715.6300 $33.5700
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Total 2695 10886.170533 $366584.8600 $33.6700
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Number of Children (Unduplicated) With at Least One Authorization 810