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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2520 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 0.766667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.766667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 321 323 329.858729 $7748.3800 $23.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 48 48 47.200000 $2409.5600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 18 18 20.468254 $1044.9000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 4.000000 $204.2000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 45 45 41.233333 $2104.9600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 27 27 25.744445 $1146.9200 $44.5500
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Subtotal (Total Children Is Unduplicated) 417 466 469.504761 $14709.9700 $31.3300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 196 197 179.934136 $8996.7600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 4.600000 $230.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 26 26 25.133334 $1256.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 96 96 62.850009 $3142.5500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 117 118 92.130167 $4606.5500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.744444 $18.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 697 721 5239.315451 $261965.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 11.142857 $557.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 79 80 438.464285 $31323.8900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.500000 $107.1600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 139 143 742.464284 $42468.9800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 298 306 1402.464284 $100192.1500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 4 4 29.785714 $2127.8900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 16.000000 $914.5600 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 0.642857 $36.7500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 323 336 1871.418256 $133694.1700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 15.571429 $890.6800 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 7.000000 $400.4000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 10 12 50.214284 $696.9800 $13.8800
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Subtotal (Total Children Is Unduplicated) 1074 2053 10193.375791 $603627.6600 $59.2200
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Total 2520 10663.647219 $618337.6300 $57.9900
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Number of Children (Unduplicated) With at Least One Authorization 1143