Summary Report for FSPSAs Ending During the Report Period Center: 52
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 1170 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 6 6 5.644445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 6 5.644445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 8 9 9.000000 $522.9900 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 9 9.000000 $522.9900 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 10 10 11.000000 $639.2100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 5.000000 $290.5500 $58.1100
SCREEN-T1023 SCREENING 15 16 16.000000 $863.6800 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 11.800000 $685.7000 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 7.000000 $406.7700 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 4.000000 $232.4400 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 17 17 88.104763 $5119.7700 $58.1100
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Subtotal (Total Children Is Unduplicated) 75 91 163.904763 $9458.4300 $57.7100
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 208 241 576.619046 $28830.9500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 4.733333 $236.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 130 136 356.666669 $17833.3500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 77 91 242.400002 $12120.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 103 104 247.166668 $12358.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 7.200000 $180.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 310 329 1526.880953 $82451.5400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 0.066667 $3.6000 $54.0300
OCCT -97530 OT SESSION BY LICENSED OT 44 49 153.728565 $12501.1900 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 2.733333 $222.2700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 7.066667 $460.1800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 42 43 164.095239 $13344.2400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 5 5 12.752380 $1037.0200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 9 10 33.742858 $2197.3400 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 1 1 0.142857 $9.3100 $65.1400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 55 55 254.257140 $20676.1700 $81.3200
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Subtotal (Total Children Is Unduplicated) 421 1073 3590.252377 $204462.1700 $56.9500
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Total 1170 3759.801585 $213920.5900 $56.9000
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Number of Children (Unduplicated) With at Least One Authorization 447