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 387 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 8 8 16.890475 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 16.890475 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 1.571429 $78.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 4 29.428572 $1471.4300 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.142857 $66.4100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.142857 $66.4100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 4 64.857142 $3768.8500 $58.1100
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Subtotal (Total Children Is Unduplicated) 10 12 98.142857 $5451.6700 $55.5500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 68 99 122.886692 $6144.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 22 25 25.230137 $630.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 32 32 44.324570 $2216.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 22 18.376191 $918.8200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 11 10.300000 $515.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 14 15 17.000000 $850.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 87 98 691.428580 $37337.1800 $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 15 16 92.163493 $7494.7400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 3 4 21.428571 $1395.4300 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 1.000000 $65.1200 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 18 20 147.752381 $12015.2500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 19 153.428572 $12476.8300 $81.3200
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Subtotal (Total Children Is Unduplicated) 194 367 1360.319187 $82753.6800 $60.8300
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Total 387 1475.352519 $88205.3500 $59.7900
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Number of Children (Unduplicated) With at Least One Authorization 203