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 470 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 91 91 98.142857 $2305.3800 $23.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 19.714286 $1006.4200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 98 98 123.857143 $3618.0900 $29.2100
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 94 101 1206.126983 $60306.3600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 17 17 141.401586 $10101.7400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 37.142857 $2124.5700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 22 22 188.607143 $13474.1000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 51 52 435.180951 $31089.3400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 9.857143 $704.1900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 23.642857 $328.1600 $13.8800
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Subtotal (Total Children Is Unduplicated) 211 372 2245.736509 $133244.2700 $59.3300
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Total 470 2369.593652 $136862.3600 $57.7600
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Number of Children (Unduplicated) With at Least One Authorization 292