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: 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 2274 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 272 272 282.734921 $6641.4400 $23.4900
OCTH -97167 OT EVAL HIGH COMPLEXITY 36 36 35.700000 $1822.4900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 22.974603 $1172.8500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 9.388889 $479.3000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 8 8 8.000000 $408.4000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 59 60 59.077778 $2631.9200 $44.5500
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Subtotal (Total Children Is Unduplicated) 363 401 417.876191 $13156.4000 $31.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 177 185 156.769833 $7838.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 21 22 17.677778 $883.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 78 80 52.961103 $2648.0200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 110 113 81.788889 $4089.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 598 649 5450.549229 $272527.4500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 12.857143 $642.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 53 53 290.499999 $20753.3100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 162 163 999.321430 $57161.1800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 286 288 1403.414280 $100259.8500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 0.571429 $40.8200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 34.428572 $1967.9400 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 1.285714 $73.4900 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 9.285714 $663.3700 $71.4400
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 282 288 1791.478571 $127983.2000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 13.500000 $772.2000 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.285714 $359.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 18 18 151.032290 $2096.3300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1017 1873 10476.707688 $610779.3200 $58.3000
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Total 2274 10894.583879 $623935.7200 $57.2700
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Number of Children (Unduplicated) With at Least One Authorization 1065