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
Eligibility Filter: Program Patients
With the filters selected there were 638 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 16 17 25.146032 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 17 25.146032 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 12.000000 $600.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 6 38.142857 $1907.1500 $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) 12 12 64.142857 $3320.6900 $51.7700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 114 174 232.453227 $11622.6700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 37 48 53.285714 $1332.1500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 69 72 62.642856 $3132.1400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 43 44 42.161112 $2108.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 21 21 18.922222 $946.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 37 39 36.437301 $1821.8700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 134 149 935.676178 $50526.5500 $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
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 6.142857 $400.0300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 18 21 103.095238 $8383.7000 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 19 19 141.016665 $11467.4800 $81.3200
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Subtotal (Total Children Is Unduplicated) 306 609 1742.604005 $100083.6100 $57.4300
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Total 638 1831.892894 $103404.3000 $56.4500
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Number of Children (Unduplicated) With at Least One Authorization 321