Summary Report for FSPSAs Ending During the Report Period Center: 06
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 1772 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 85.175397 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 64 65 85.175397 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 172 176 141.785714 $7089.2900 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 172 176 141.785714 $7089.2900 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 0.622222 $43.1500 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 138 145 141.357786 $7067.8900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 53 56 45.735238 $2286.7600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 56 57 31.149946 $778.7600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 11 15.244446 $762.2300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 3 4.383333 $219.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 3.583333 $89.5800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 8 10.266667 $513.3400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 1.922222 $96.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.883334 $97.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.333334 $16.6700 $50.0100
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.433333 $35.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 5.388889 $269.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.033333 $25.8300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 2.285714 $114.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 259 288 1866.219036 $100775.9200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 14 16 88.500002 $4778.9900 $54.0000
INTR -T1013 INTERPRETER 56 72 302.647617 $15132.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 722 836 5322.542836 $63870.5600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 26.723810 $2173.1800 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 5.642857 $458.8800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.428571 $288.3900 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 13.571428 $883.7800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 1 1 6.142857 $499.5400 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 6 42.714286 $3473.5300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 2 12.428571 $1010.6900 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 796 1531 7961.185001 $210761.9600 $26.4700
-------------------------------------------------------------------------------------------------------------------------------------
Total 1772 8188.146112 $217851.2400 $26.6100
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 874