Summary Report for FSPSAs Ending During the Report Period Center: 09
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 364 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 13 13 17.487302 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 13 17.487302 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.285714 $114.2900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 14.514286 $725.7200 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 4 25.857143 $1502.5600 $58.1100
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Subtotal (Total Children Is Unduplicated) 9 9 42.657143 $2342.5600 $54.9200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 71 114 147.285713 $7364.3000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 15 16 15.500000 $387.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 39 40 32.022221 $1601.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 21 21 19.011110 $950.5500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 8 7.388888 $369.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 19 19 17.261110 $863.0500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 85 90 531.604760 $28706.6600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 75.428570 $6133.8600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 8 8 65.142857 $5297.4300 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 15 125.999999 $10246.3300 $81.3200
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Subtotal (Total Children Is Unduplicated) 189 342 1038.645228 $61970.2200 $59.6600
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Total 364 1098.789673 $64312.7900 $58.5300
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Number of Children (Unduplicated) With at Least One Authorization 203