Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 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 580 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 66 68 52.407939 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 66 68 52.407939 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 8.000000 $388.0000 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.246575 $7.8400 $31.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.227778 $13.2400 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 10 5.883334 $341.8800 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 10 7.811111 $453.9000 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 22 12.888889 $748.9700 $58.1100
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Subtotal (Total Children Is Unduplicated) 41 53 35.057687 $1953.8400 $55.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 5.000000 $25000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 10 13.600001 $680.0100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 56 62 80.877782 $4043.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 28 44.788888 $2239.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 62 64 89.099998 $4454.9900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 163 215 942.047615 $50870.5400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 10.142857 $547.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 17 92.828571 $7548.8100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 18 19 79.761905 $6486.2500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 33 38 153.476190 $12480.6800 $81.3200
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Subtotal (Total Children Is Unduplicated) 300 459 1511.623807 $114352.3500 $75.6500
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Total 580 1599.089433 $116306.1900 $72.7300
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Number of Children (Unduplicated) With at Least One Authorization 364