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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 629 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 70 47.444448 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 66 70 47.444448 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 9 10 8.694444 $421.6800 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 12 7.105556 $412.9100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 11 6.650001 $386.4400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 14 16 7.927774 $460.6600 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 40 49 30.377775 $1681.6800 $55.3600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 8.622223 $431.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 69 73 88.422225 $4421.1300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 46 49 56.766667 $2838.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 83 87 118.241269 $5912.0600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 188 217 955.061902 $51573.3600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 1.285714 $69.4300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 20 93.566667 $7608.8500 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 18 22 55.271428 $4494.6800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 26 29 107.609523 $8750.8000 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 345 510 1487.847618 $101099.7500 $67.9500
-------------------------------------------------------------------------------------------------------------------------------------
Total 629 1565.669841 $102781.4400 $65.6500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 409