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: 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 1137 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 148 149 156.098413 $3666.7500 $23.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 28 28 28.000000 $1429.4000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 7 25.714286 $1312.7200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 23 23 22.933333 $1170.7500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 5.000000 $222.7500 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 195 213 238.746032 $7853.4100 $32.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 77 77 107.382543 $5369.1400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.388889 $9.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 13 13 11.422223 $571.1200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 28 28 26.005555 $1300.2800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 49 49 57.044446 $2852.2300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.533333 $13.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 316 336 3733.694042 $186684.7100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 72 72 599.068253 $42797.4400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 28 28 187.607142 $10731.1200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 123 123 805.071431 $57514.3200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.785714 $341.8900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 180 184 1337.420640 $95545.3600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 9.857143 $704.1900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 18.642857 $1066.3700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 84.357143 $1170.8800 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 534 924 6984.281354 $411672.0800 $58.9400
-------------------------------------------------------------------------------------------------------------------------------------
Total 1137 7223.027386 $419525.5000 $58.0800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 574