Summary Report for FSPSAs Initiated During the Report Period Center: 09
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 373 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 11 12 13.569841 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 12 13.569841 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 3.088889 $154.4500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 25.000000 $1250.0000 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 5 5 32.238095 $1873.3600 $58.1100
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Subtotal (Total Children Is Unduplicated) 13 13 60.326984 $3277.8100 $54.3300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 74 112 142.285713 $7114.3000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 15 16 15.500000 $387.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 49 50 51.450001 $2572.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 26 26 33.033334 $1651.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 8.311112 $415.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 23 24 22.305556 $1115.2800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.072222 $26.8100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 66 69 458.923817 $24781.8900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 82.857143 $6737.9600 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 9.714286 $632.6000 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 10 11 103.752381 $8437.1700 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 18 118.953969 $9673.3500 $81.3200
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Subtotal (Total Children Is Unduplicated) 185 348 1050.159534 $63596.5700 $60.5600
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Total 373 1124.056359 $66874.3800 $59.4900
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Number of Children (Unduplicated) With at Least One Authorization 196