Summary Report for FSPSAs Ending During the Report Period Center: 03
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: 04-01-25 and 06-30-25 Date of Report: 07-19-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 552 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 69 71 37.466667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 69 71 37.466667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 6 6.000000 $291.0000 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.257534 $8.1900 $31.8100
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 14 7.072223 $410.9700 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.361111 $20.9800 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 10 6.166667 $358.3500 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 16 17 11.011110 $639.8500 $58.1100
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Subtotal (Total Children Is Unduplicated) 38 50 30.868645 $1729.3400 $56.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 5.000000 $25000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 10 9.877777 $493.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 59 64 67.233337 $3361.6900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 32 33.942859 $1697.1600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 61 68 75.211115 $3760.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 169 197 774.971422 $41848.4900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 20 57.685714 $4691.0200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 10 12 50.657141 $4119.4500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 23 78.266666 $6364.6600 $81.3200
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Subtotal (Total Children Is Unduplicated) 302 431 1152.846031 $91336.9100 $79.2300
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Total 552 1221.181343 $93066.2600 $76.2100
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Number of Children (Unduplicated) With at Least One Authorization 375