Summary Report for FSPSAs Initiated During the Report Period Center: 09
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1537 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 18 19 24.992063 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 18 19 24.992063 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 12 13 41.653969 $2082.7000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 9 67.142858 $3357.1400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 8.285714 $481.4900 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.142857 $124.5200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 4 13.428571 $780.3300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 7 7 80.857143 $4698.6100 $58.1100
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Subtotal (Total Children Is Unduplicated) 30 38 214.511112 $11582.8900 $54.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 153 247 306.478864 $15323.9300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 59 69 66.182976 $1654.5700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 107 112 125.420991 $6271.0500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 54 56 58.273016 $2913.6600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 3.588889 $89.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 45 40.392008 $2019.6000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 53 57 55.245682 $2762.2800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 617 705 4644.966717 $250828.2700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 11.000000 $594.0000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 58 323.127782 $26276.7300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 7 9 48.033334 $3127.9400 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 1.000000 $65.1200 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 40 43 287.623811 $23389.6100 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 2.714286 $176.7600 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 65 69 427.411908 $34757.1600 $81.3200
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Subtotal (Total Children Is Unduplicated) 665 1480 6404.460264 $370325.3700 $57.8200
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Total 1537 6643.963439 $381908.2700 $57.4800
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Number of Children (Unduplicated) With at Least One Authorization 680