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 633 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
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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 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 2 4.133333 $240.1900 $58.1100
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Subtotal (Total Children Is Unduplicated) 4 6 8.133333 $472.6300 $58.1100
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 211 234 500.333330 $25016.6500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 126 136 323.533327 $16176.6400 $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 20 20 83.057143 $4485.0800 $54.0000
INTR -T1013 INTERPRETER 3 3 19.952381 $997.6300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 1.200000 $97.5800 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 9.142857 $743.5000 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 11.542857 $751.6700 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 3 4 9.285715 $755.1100 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 5.300000 $431.0000 $81.3200
PHY -97110HM PT SESSION BY PT ASST 2 2 5.666667 $369.0200 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 6 16.723810 $1359.9800 $81.3200
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Subtotal (Total Children Is Unduplicated) 265 622 1574.171414 $79565.4900 $50.5400
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Total 633 1584.971414 $80038.1100 $50.5000
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Number of Children (Unduplicated) With at Least One Authorization 270