Summary Report for FSPSAs Ending During the Report Period Center: 09
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1482 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 19 20 25.714285 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 20 25.714285 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 5 5.000000 $250.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 14 63.919048 $3195.9600 $50.0000
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 2.571428 $149.4200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 8 9 56.285715 $3270.7600 $58.1100
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Subtotal (Total Children Is Unduplicated) 27 30 127.776191 $6866.1400 $53.7400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 148 239 289.848727 $14492.4300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 55 67 69.807634 $1745.1900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 106 115 94.111111 $4705.5600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 56 60 55.250001 $2762.5100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 34 36 30.855556 $1542.7800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 49 54 48.107686 $2405.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.000000 $50.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 589 678 4412.866631 $238294.8000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 45 50 272.544447 $22163.3000 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 7 8 37.938095 $2470.5300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 43 49 298.938093 $24309.6400 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 3.428571 $223.2700 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 63 68 482.945236 $39273.0900 $81.3200
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Subtotal (Total Children Is Unduplicated) 649 1432 6103.641788 $354563.4600 $58.0900
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Total 1482 6257.132264 $361429.6100 $57.7600
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Number of Children (Unduplicated) With at Least One Authorization 669