Summary Report for FSPSAs Ending During the Report Period Center: 09
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 317 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 12 12 13.684125 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 12 12 13.684125 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 14.142857 $707.1500 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 11.428571 $664.1200 $58.1100
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Subtotal (Total Children Is Unduplicated) 4 4 25.571428 $1371.2600 $53.6200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 50 75 117.500000 $5875.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 4.000000 $100.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 45 49 40.016666 $2000.8300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 26 24.544445 $1227.2300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 11 8.311111 $415.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 27 28 24.255555 $1212.7800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 78 81 585.376186 $31610.3500 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 64.428570 $5239.3300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 11 11 86.999998 $7074.8400 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 8 51.642858 $4199.5900 $81.3200
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Subtotal (Total Children Is Unduplicated) 166 301 1007.075389 $58955.5000 $58.5400
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Total 317 1046.330942 $60326.7600 $57.6600
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Number of Children (Unduplicated) With at Least One Authorization 181