Summary Report for FSPSAs Initiated During the Report Period Center: 09
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 338 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 13 13 15.100001 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 13 15.100001 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 1.300000 $65.0000 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 17.571429 $1021.0800 $58.1100
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Subtotal (Total Children Is Unduplicated) 4 4 18.871429 $1086.0800 $57.5500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 50 75 115.500000 $5775.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 6.000000 $150.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 43 44 36.238889 $1811.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 26 22.077778 $1103.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 9 7.344445 $367.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 26 27 23.227778 $1161.3900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 93 99 700.485719 $37826.2400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 9 43.428573 $3531.6100 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 0.142857 $9.3100 $65.1400
PHY -97110 PT SESSION BY LICENSED PT 12 12 87.000000 $7074.8600 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 13 87.107143 $7083.5700 $81.3200
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Subtotal (Total Children Is Unduplicated) 179 321 1128.553182 $65895.0400 $58.3900
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Total 338 1162.524612 $66981.1200 $57.6200
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Number of Children (Unduplicated) With at Least One Authorization 193