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
Eligibility Filter: Program Patients
With the filters selected there were 623 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 4 4 1.955555 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 1.955555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
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Subtotal (Total Children Is Unduplicated) 3 3 3.000000 $174.3300 $58.1100
EI Services, Class # 03
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.500000 $12.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 212 260 592.150004 $29607.5200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 109 116 337.400000 $16870.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 67 78 195.933334 $9796.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 116 118 315.566670 $15778.3500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 9.400000 $235.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 24 29 119.342856 $6444.5200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 33.471429 $2721.8900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 1.666667 $135.5400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 3.333333 $271.0600 $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) 263 616 1612.630960 $82187.4800 $50.9600
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Total 623 1617.586515 $82361.8100 $50.9200
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Number of Children (Unduplicated) With at Least One Authorization 267