Summary Report for FSPSAs Ending During the Report Period Center: 52
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 361 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 3 3 1.533333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 1.533333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 1 1 1.000000 $58.1100 $58.1100
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 124 157 353.616669 $17680.8500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 71 77 218.333334 $10916.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 37 43 99.333334 $4966.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 58 59 140.566669 $7028.3500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.266667 $31.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11 14 56.209523 $3035.3200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 17.757143 $1444.0100 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 3.466667 $281.9100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.400000 $32.5300 $81.3200
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Subtotal (Total Children Is Unduplicated) 148 357 890.950006 $45417.9700 $50.9800
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Total 361 893.483339 $45476.0800 $50.9000
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Number of Children (Unduplicated) With at Least One Authorization 151