Summary Report for FSPSAs Ending During the Report Period Center: 04
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end 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 ending 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 1089 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 52 53 25.169838 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 52 53 25.169838 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165TL OT EVAL LOW COMPLEXITY 2 2 0.900000 $52.3000 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 3 3 0.972222 $56.4900 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 10 10 2.250000 $130.7500 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 9 9 2.716667 $157.8700 $58.1100
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Subtotal (Total Children Is Unduplicated) 17 24 6.838889 $397.4100 $58.1100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 54 12.822222 $641.1100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 5 2.366667 $118.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 6 1.909523 $95.4800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.766667 $38.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 0.544445 $27.2300 $50.0100
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 10 27.999999 $756.0100 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 177 188 1280.285711 $69135.4400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 0.714286 $38.5700 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 660 709 4956.265077 $59475.1900 $12.0000
OCCT -97530TL OT SESSION BY LICENSED OT 6 7 35.285714 $2869.4500 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 13 14 57.785716 $4699.1500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 11 12 65.000002 $5285.8200 $81.3200
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Subtotal (Total Children Is Unduplicated) 706 1012 6441.746029 $143180.1000 $22.2300
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Total 1089 6473.754756 $143577.5100 $22.1800
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Number of Children (Unduplicated) With at Least One Authorization 749