Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 640 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 64 65 33.492062 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 64 65 33.492062 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 9 9 7.227778 $350.5500 $48.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.144444 $66.5000 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 13 5.611111 $326.0600 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 8 8 4.111112 $238.9000 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 14 8.037302 $467.0500 $58.1100
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Subtotal (Total Children Is Unduplicated) 38 46 26.131747 $1449.0700 $55.4500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 11 14.066667 $703.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 54 61 76.444445 $3822.2300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 56 59.505553 $2975.2700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 85 96 86.472226 $4323.6300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 3.266667 $163.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 156 221 775.552388 $41879.8100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 22 25 70.852381 $5761.7100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 24 25 72.085715 $5862.0100 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 30 68.190476 $5545.2500 $81.3200
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Subtotal (Total Children Is Unduplicated) 326 529 1229.436518 $86036.5700 $69.9800
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Total 640 1289.060327 $87485.6300 $67.8700
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Number of Children (Unduplicated) With at Least One Authorization 391