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
Eligibility Filter: Program Patients
With the filters selected there were 480 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 18 18 22.995237 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 18 18 22.995237 $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 76 117 182.750000 $9137.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 7.000000 $175.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 68 73 62.861110 $3143.0500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 34 38 35.955556 $1797.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 16 17 13.788889 $689.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 41 42 37.166666 $1858.3300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 120 130 879.961896 $47518.0100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 10 95.142856 $7737.0200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 13 14 116.319046 $9459.0600 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 10 70.928572 $5767.9100 $81.3200
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Subtotal (Total Children Is Unduplicated) 235 458 1501.874591 $87283.1100 $58.1200
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Total 480 1550.441256 $88654.3700 $57.1800
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Number of Children (Unduplicated) With at Least One Authorization 256