Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 10-01-24 and 12-31-24 Date of Report: 03-31-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 608 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 70 72 31.555554 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 70 72 31.555554 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 12 13 13.000000 $630.5000 $48.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 3 1.400000 $81.3500 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 8 8 3.983334 $231.4800 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 5.527777 $321.2100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 16 18 9.905555 $575.6100 $58.1100
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Subtotal (Total Children Is Unduplicated) 39 51 33.816666 $1840.1500 $54.4200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 4.194445 $20972.5000 $5000.0700
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 7.822223 $391.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 54 59 61.657143 $3082.8600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 39 41.111113 $2055.5700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 74 79 82.100002 $4105.0100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 190 222 808.347606 $43650.7500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 13.142857 $709.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 15 53.190474 $4325.4500 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 20 20 51.142857 $4158.9400 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 35 116.666663 $9487.3300 $81.3200
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Subtotal (Total Children Is Unduplicated) 342 485 1239.375383 $92939.2400 $74.9900
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Total 608 1304.747603 $94779.3900 $72.6400
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Number of Children (Unduplicated) With at Least One Authorization 414