Summary Report for FSPSAs Initiated During the Report Period Center: 04
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: 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 649 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 28 28 15.544445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 28 28 15.544445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $61.7100 $61.7100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 8 9 2.611109 $151.7200 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 5 6 1.744443 $101.3600 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 5 5 1.338888 $77.8000 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.544444 $31.6400 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.255556 $14.8500 $58.1200
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Subtotal (Total Children Is Unduplicated) 12 24 7.494440 $439.0800 $58.5900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 21 46 13.183338 $659.1900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 1.266666 $63.3300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 1.895237 $94.7600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.300000 $15.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 1.122222 $56.1100 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 4 20.571429 $555.4300 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 91 99 774.857153 $41842.2800 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 391 413 3142.074657 $37704.8900 $12.0000
OCCT -97530TL OT SESSION BY LICENSED OT 8 8 63.285715 $5146.3900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 1 1 3.500000 $284.6200 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 6 7 59.285715 $4821.1200 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 7 7 56.571429 $4600.3900 $81.3200
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Subtotal (Total Children Is Unduplicated) 423 597 4137.913561 $95843.5100 $23.1600
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Total 649 4160.952446 $96282.5800 $23.1400
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Number of Children (Unduplicated) With at Least One Authorization 450