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 595 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 9 9 18.157142 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 18.157142 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 5 7.285715 $364.2900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 5 39.428572 $1971.4300 $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) 14 16 113.857143 $6237.3900 $54.7800
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 113 172 220.040507 $11002.0300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 50 54.515851 $1362.9000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 53 54 62.945205 $3147.2700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 32 32 27.792858 $1389.6500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 22 20.038889 $1001.9500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 33 34 34.426190 $1721.3100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.000000 $50.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 124 136 932.728586 $50367.3600 $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 16 17 104.020636 $8458.9600 $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
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 6.142857 $400.0300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 19 21 151.895238 $12352.1500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 20 166.000001 $13499.1400 $81.3200
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Subtotal (Total Children Is Unduplicated) 295 570 1818.975389 $106882.2700 $58.7600
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Total 595 1950.989674 $113119.6600 $57.9800
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Number of Children (Unduplicated) With at Least One Authorization 306