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
Eligibility Filter: Program Patients
With the filters selected there were 2725 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 25 27 31.436508 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 25 27 31.436508 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 21 24 75.704763 $3785.2400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 12 15 84.219049 $4210.9600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 2.000000 $116.2200 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 5 6 18.285714 $1062.5900 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 10.000000 $581.1000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 11 12 27.142857 $1577.2700 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 4 13.428571 $780.3300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 25 26 239.571428 $13921.5100 $58.1100
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Subtotal (Total Children Is Unduplicated) 71 95 472.352382 $26151.4300 $55.3600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 269 435 581.424232 $29071.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 101 122 122.617027 $3065.4200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 166 174 183.740146 $9187.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 86 89 88.221538 $4411.0800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 4.011111 $100.2800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 69 71 68.997564 $3449.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 93 100 98.927427 $4946.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.422222 $60.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 944 1068 7014.466756 $378781.2100 $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 121 135 803.954663 $65377.5600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 4.857143 $394.9800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 12 14 90.604764 $5900.1800 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 1.000000 $65.1200 $65.1200
OCCT -97530TLGTHM OT SESSION BY OT ASST 2 3 24.285714 $1581.4900 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 130 145 940.765370 $76503.0300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 5 5 20.923809 $1362.5600 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 210 229 1584.573823 $128857.5300 $81.3200
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Subtotal (Total Children Is Unduplicated) 1131 2603 11648.793309 $713759.4300 $61.2700
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Total 2725 12152.582199 $739910.8600 $60.8900
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Number of Children (Unduplicated) With at Least One Authorization 1151