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 1592 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 1 1 0.411111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 0.766667 $0.0000 $0.0000
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 7 8 3.623015 $184.9500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 7 2.227777 $113.7200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 24 24 11.142064 $568.8100 $51.0500
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Subtotal (Total Children Is Unduplicated) 31 42 17.576189 $911.4100 $51.8500
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 82 88 477.928572 $23896.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 718 771 4638.686488 $46386.8700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 13.809524 $986.5600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 7 7 33.428572 $2388.1300 $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 13 13 81.071427 $5791.7400 $71.4400
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Subtotal (Total Children Is Unduplicated) 732 1548 5558.424185 $95140.6000 $17.1200
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Total 1592 5576.767041 $96052.0000 $17.2200
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Number of Children (Unduplicated) With at Least One Authorization 738