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
Eligibility Filter: Program Patients
With the filters selected there were 667 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 6 6 1.800000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 6 1.800000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SCREEN-T1023 SCREENING 2 2 2.000000 $107.9600 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $116.2200 $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) 8 8 16.857143 $971.3100 $57.6200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.500000 $12.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 231 264 612.316664 $30615.8200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.400000 $20.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 128 133 346.266663 $17313.3200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 74 89 263.200000 $13160.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 114 119 280.533332 $14026.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 4 3.700000 $92.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 26 30 125.952383 $6801.4200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 15.280953 $1242.6400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 2.066667 $168.0600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.800000 $227.7000 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 15.633334 $1271.3100 $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) 290 653 1682.792853 $86039.3900 $51.1300
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Total 667 1701.449996 $87010.7000 $51.1400
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Number of Children (Unduplicated) With at Least One Authorization 297