Summary Report for FSPSAs Initiated During the Report Period Center: 09
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: 01-01-24 and 03-31-24 Date of Report: 04-04-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 476 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 24 25 41.392063 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 24 25 41.392063 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.066667 $53.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 8.714286 $435.7200 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 17.857142 $1037.6800 $58.1100
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Subtotal (Total Children Is Unduplicated) 4 4 27.638095 $1526.7300 $55.2400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 94 143 213.500000 $10675.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 12 13 15.000000 $375.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 67 70 58.638890 $2931.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 35 35 32.572222 $1628.6100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 14 14 11.155556 $557.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 41 43 39.766668 $1988.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 94 99 578.542861 $31241.2700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 52.571428 $4275.1100 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 0.571429 $37.2100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 11 12 109.142856 $8875.5100 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 10 64.000000 $5204.4700 $81.3200
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Subtotal (Total Children Is Unduplicated) 223 447 1175.461910 $67790.2500 $57.6700
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Total 476 1244.492068 $69316.9900 $55.7000
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Number of Children (Unduplicated) With at Least One Authorization 249