Summary Report for FSPSAs Ending During the Report Period Center: 04
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 1832 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 50 51 21.122221 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 50 51 21.122221 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.416667 $24.2100 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.050000 $2.9100 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 49 51 12.622224 $733.4900 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.416667 $24.2100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 37 39 10.311111 $599.1800 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 33 35 8.044444 $467.4600 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.061111 $3.5500 $58.1000
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.322222 $18.7200 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 11.142857 $647.5100 $58.1100
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Subtotal (Total Children Is Unduplicated) 83 133 43.387303 $2521.2500 $58.1100
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 5.405556 $1252.0500 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 34 86 17.927787 $896.4400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 0.388889 $19.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 0.966666 $48.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 1.155556 $57.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 1.633333 $81.6700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 0.100000 $5.0000 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 108 133 750.142854 $20253.8600 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 532 568 3430.857106 $185266.3300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 22.000000 $1188.0000 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 529 573 3482.342821 $41788.1300 $12.0000
OCCT -97530TL OT SESSION BY LICENSED OT 92 99 515.764277 $41941.9600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 3 14.428571 $1173.3300 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 62 67 372.978564 $30330.6500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 2 14.357143 $1167.5300 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.000000 $260.4800 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 86 98 423.928563 $34473.8900 $81.3200
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Subtotal (Total Children Is Unduplicated) 679 1648 9058.377686 $360204.8600 $39.7600
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Total 1832 9122.887210 $362726.1000 $39.7600
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Number of Children (Unduplicated) With at Least One Authorization 724