Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 1208 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 5 5 2.666667 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5 5 2.666667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 12 12 11.233333 $652.7700 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 10 11 12.733333 $739.9300 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 8 9 10.000000 $581.1000 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 4.800000 $278.9300 $58.1100
SCREEN-T1023 SCREENING 19 19 19.000000 $1025.6200 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 8 9 9.800000 $569.4800 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $116.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 4.000000 $232.4400 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 4.000000 $232.4400 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 14 16 54.180954 $3148.4600 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 70 90 132.747620 $7635.4900 $57.5200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.400000 $20.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 213 236 502.166663 $25108.3200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 129 139 327.233327 $16361.6400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 74 87 269.399996 $13469.9800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 107 110 277.033330 $13851.6500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 13 41.600001 $1040.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 321 335 1339.444052 $72329.9900 $54.0000
INTR -T1013 INTERPRETER 3 3 19.952381 $997.6300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 47 53 169.523812 $13785.6800 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 2 2 9.476190 $770.6000 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 9 9 40.200001 $2617.8300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 46 49 182.580956 $14847.4900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 3 8.266667 $672.2500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 8 10 44.285715 $2883.8800 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 1 1 12.714286 $827.9600 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 60 62 247.928578 $20161.5600 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 445 1113 3492.205955 $199746.4500 $57.2000
-------------------------------------------------------------------------------------------------------------------------------------
Total 1208 3627.620242 $207381.9500 $57.1700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 467