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
Eligibility Filter: Program Patients
With the filters selected there were 479 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 19 19 20.063493 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 19 20.063493 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 2.142857 $107.1500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 1.300000 $65.0000 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 4 28.714286 $1668.5900 $58.1100
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Subtotal (Total Children Is Unduplicated) 6 6 32.157143 $1840.7400 $57.2400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 74 112 171.750000 $8587.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 10 10.000000 $250.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 61 62 50.272222 $2513.6100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 35 37 29.600000 $1480.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 14 11.455556 $572.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 36 37 32.283334 $1614.1700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 131 141 944.500007 $51003.0300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 10 45.571430 $3705.8700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 2.000000 $130.2400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 15 15 102.571429 $8341.1200 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 14 106.250000 $8640.2700 $81.3200
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Subtotal (Total Children Is Unduplicated) 241 454 1506.253978 $86838.6000 $57.6500
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Total 479 1558.474614 $88679.3300 $56.9000
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Number of Children (Unduplicated) With at Least One Authorization 262