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 1322 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
----------------------------------------------------------------------------
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 283 283 288.714286 $6781.9000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 16 16 15.211111 $776.5300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 4.811111 $245.6100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.388889 $70.9000 $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 10 10 10.000000 $445.5000 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 311 320 324.125397 $8486.4100 $26.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 211 220 178.636504 $8931.8100 $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 297 317 2335.694433 $116784.7400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 17 17 128.744444 $9197.5000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 42 42 288.928571 $16526.7300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 73 74 354.931743 $25356.3600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 5.428571 $310.3000 $57.1600
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 95 96 628.483724 $44898.9000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 8 8 31.535714 $437.7200 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 570 1000 4144.331328 $242018.6100 $58.4000
-------------------------------------------------------------------------------------------------------------------------------------
Total 1322 4469.645614 $250505.0200 $56.0500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 797