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 413 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 12 13 19.557142 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 12 13 19.557142 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 5 28.142857 $1407.1500 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 14.000000 $813.5400 $58.1100
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Subtotal (Total Children Is Unduplicated) 9 9 43.142857 $2270.6900 $52.6300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 67 99 116.156555 $5807.8300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 19 22 23.000000 $575.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 44 46 41.200000 $2060.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 29 30 28.744445 $1437.2300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 11 9.850000 $492.5000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 19 21 20.300000 $1015.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 92 104 667.714280 $36056.5900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 13 79.627778 $6475.3300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 3 4 27.142857 $1767.5400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 17 19 95.809524 $7791.2200 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 18 129.588094 $10538.1000 $81.3200
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Subtotal (Total Children Is Unduplicated) 198 391 1243.133533 $74116.3400 $59.6200
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Total 413 1305.833532 $76387.0300 $58.5000
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Number of Children (Unduplicated) With at Least One Authorization 210