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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2971 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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $23.5000 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 390 391 412.780951 $9700.3500 $23.5000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 6.000000 $306.3000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 60 63 97.266667 $4965.4700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 12.066667 $616.0000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 9.428571 $481.3300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 72 82 81.968255 $4184.4800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $133.6500 $44.5500
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Subtotal (Total Children Is Unduplicated) 504 563 623.511111 $20411.0800 $32.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.000000 $100.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $68.8600 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 15.428571 $3548.5800 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 194 204 227.696040 $11384.8400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 0.577778 $28.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 40 41 36.588892 $1829.4600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 35 47.901589 $2395.0900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 127 128 128.000003 $6400.0200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 763 914 6799.336094 $339966.7100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 272 294 1811.661099 $129425.1800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 16 17 114.499998 $6549.4200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 305 328 1771.123805 $126529.1600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 10 10 41.428570 $2368.0600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 371 409 2523.101581 $180250.4800 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 14 14 79.642857 $1105.4400 $13.8800
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Subtotal (Total Children Is Unduplicated) 1170 2408 13600.986877 $816950.1800 $60.0700
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Total 2971 14224.497988 $837361.2700 $58.8700
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Number of Children (Unduplicated) With at Least One Authorization 1204