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
Eligibility Filter: Program Patients
With the filters selected there were 533 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 15 15 21.109524 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 15 21.109524 $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 5 5 27.857143 $1618.7800 $58.1100
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Subtotal (Total Children Is Unduplicated) 10 10 44.657143 $2458.7800 $55.0600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 105 169 204.528568 $10226.4400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 24 27 26.750000 $668.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 56 57 46.383333 $2319.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 31 31 26.822222 $1341.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 13 11.777777 $588.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 32 32 30.016666 $1500.8300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 121 140 769.885714 $41573.8200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 10 75.999999 $6180.3300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 10.285714 $669.8000 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 9 10 69.714286 $5669.1700 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 16 127.714285 $10385.7400 $81.3200
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Subtotal (Total Children Is Unduplicated) 263 508 1401.878564 $81174.0400 $57.9000
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Total 533 1467.645231 $83632.8200 $56.9800
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Number of Children (Unduplicated) With at Least One Authorization 280