Summary Report for FSPSAs Ending During the Report Period Center: 10
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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2971 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 2 2 1.188889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.188889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 431 431 444.920635 $10451.1900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $27.7400 $13.8700
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 52 53 52.211111 $2665.3800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 14.100000 $719.8100 $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 8 8 7.388889 $377.2000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 5 5 5.000000 $255.2500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 62 63 61.800000 $2753.1900 $44.5500
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Subtotal (Total Children Is Unduplicated) 530 580 590.420635 $17401.8500 $29.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 211 222 179.403171 $8970.1400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 23 23 16.633335 $831.6800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 69 71 70.458729 $3522.9300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 120 124 98.022226 $4901.1300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.833334 $70.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 878 938 6922.590455 $346129.5600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 8.428571 $421.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 80 84 454.030160 $32435.9300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 197 202 1135.435709 $64946.9900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 334 341 1502.142065 $107313.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 6 33.357143 $1906.6900 $57.1600
SENS -V5264 EARMOLD 3 3 3.000000 $54.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 323 334 1997.412293 $142695.2400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.000000 $57.2000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 32 32 116.964285 $1623.4700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1294 2389 12545.711476 $726340.3800 $57.9000
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Total 2971 13137.321000 $743742.2400 $56.6100
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Number of Children (Unduplicated) With at Least One Authorization 1374