Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 366 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 2 2 0.444444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 0.444444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 9.857143 $572.8000 $58.1100
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Subtotal (Total Children Is Unduplicated) 2 2 10.857143 $630.9100 $58.1100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 2.000000 $100.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 136 162 407.516667 $20375.8400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 76 78 223.799999 $11190.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 36 46 172.400001 $8620.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 56 58 162.333333 $8116.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 2 1.166667 $29.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 10 47.085716 $2542.6300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 12.423810 $1010.3000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 1 1 0.066667 $5.4200 $81.3600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 2.666667 $216.8600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 12.142857 $987.4600 $81.3200
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Subtotal (Total Children Is Unduplicated) 162 362 1043.602384 $53194.3400 $50.9700
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Total 366 1054.903971 $53825.2500 $51.0200
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Number of Children (Unduplicated) With at Least One Authorization 164