Summary Report for FSPSAs Initiated During the Report Period Center: 05
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: 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 1073 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 23 23 24.233332 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 23 23 24.233332 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 1 1 1.000000 $50.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 9.000000 $539.2800 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 23 23 45.000000 $3644.1000 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 18 18 34.500000 $2793.8100 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 10 10 18.000000 $1457.6400 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 15 15 30.000000 $2429.4000 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 11 11 18.500000 $1498.1300 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 33 33 59.500000 $3565.2400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 33 33 64.500000 $3864.8400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.566667 $32.9300 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 2.511111 $145.9200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 0.472222 $27.4400 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 3 0.372222 $21.6300 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.300000 $75.5400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.494444 $86.8400 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.066667 $3.8800 $58.1400
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Subtotal (Total Children Is Unduplicated) 92 174 305.783333 $21727.1400 $71.0500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 17 18 14.111415 $70557.0000 $4999.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 58 49.417461 $2470.8800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 16 20 20.533334 $1026.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 199 210 202.270627 $10113.4900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 60 65 72.111109 $3605.5500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 3.676190 $91.9100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 44 47 46.144443 $2307.2200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 37 37 36.819045 $1840.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 0.177778 $4.4500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 78 82 81.638884 $4081.9200 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 49 53 37.211104 $1860.5200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 94 96 84.790473 $4239.5000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 58 60 41.404757 $2070.2100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 7.100000 $177.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 7.166666 $193.5000 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 73 79 449.938103 $24296.6500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 11 38.761907 $2093.1400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 12 91.285716 $7423.3500 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 5.714286 $464.6900 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 4.000000 $325.2800 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 10.714286 $871.2900 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 7.142857 $580.8600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 6 7 30.357143 $2468.6500 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 2.000000 $162.6400 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 18.285715 $1486.9900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.714286 $139.4100 $81.3200
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Subtotal (Total Children Is Unduplicated) 294 876 1364.487585 $144954.1700 $106.2300
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Total 1073 1694.504250 $166681.3100 $98.3700
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Number of Children (Unduplicated) With at Least One Authorization 366