Summary Report for FSPSAs Ending During the Report Period Center: 06
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 1608 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 56 57 43.241267 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 56 57 43.241267 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 153 153 152.142857 $7607.1500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 154 155 156.142857 $7876.9900 $50.4500
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.266667 $87.8500 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 111 113 95.101912 $4755.1100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 69 70 59.613125 $2980.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 29 30 29.559846 $739.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 4 3.900000 $195.0000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 7 5.466667 $273.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.671429 $66.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 2.800000 $140.0000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 5 6 7.866667 $393.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 3 1.833334 $91.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 2.366667 $118.3400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 3 2.900000 $145.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.600000 $15.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 223 261 1556.719032 $84062.8800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 14 15 90.785713 $4902.4300 $54.0000
INTR -T1013 INTERPRETER 106 165 454.849999 $22742.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 587 690 3924.228534 $47090.7600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 9.857143 $801.5800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 6 7 43.285714 $3519.9900 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 2.464286 $160.4800 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 11 58.285713 $4739.8000 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.857143 $394.9800 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 709 1396 6361.279591 $178416.4800 $28.0500
-------------------------------------------------------------------------------------------------------------------------------------
Total 1608 6560.663715 $186293.4600 $28.4000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 779