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 1088 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 223 224 230.858729 $5422.8700 $23.4900
OCTH -97167 OT EVAL HIGH COMPLEXITY 13 13 13.000000 $663.6500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 5.857143 $299.0100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 10 10 9.766667 $498.5900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 5.000000 $222.7500 $44.5500
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Subtotal (Total Children Is Unduplicated) 247 255 264.482539 $7106.8700 $26.8700
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 194 195 177.800803 $8890.0900 $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 206 212 1588.920630 $79446.0300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 15 99.142857 $7082.7800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.500000 $107.1600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 23 25 122.571428 $7011.0900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 46 49 241.857143 $17278.2900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 5.142857 $293.9700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 81 85 472.828576 $33778.8500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.714286 $269.6600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 4 6 34.785714 $482.8300 $13.8800
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Subtotal (Total Children Is Unduplicated) 445 832 2934.722248 $163895.1000 $55.8500
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Total 1088 3199.971454 $171001.9700 $53.4400
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Number of Children (Unduplicated) With at Least One Authorization 631