Summary Report for FSPSAs Ending During the Report Period Center: 52
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 566 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 5 6 2.022223 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 6 2.022223 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
SCREEN-T1023 SCREENING 1 1 1.000000 $53.9800 $53.9800
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Subtotal (Total Children Is Unduplicated) 1 1 1.000000 $53.9800 $53.9800
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 4.033333 $201.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 207 254 583.316660 $29165.8000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.400000 $35.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 82 87 233.599992 $11679.9600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.300000 $7.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 65 189.766665 $9488.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 103 110 258.766663 $12938.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 23.733332 $593.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 26 27 88.438094 $4775.6600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 0.700000 $56.9200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 1 1 0.714286 $58.0900 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 8.066667 $655.9800 $81.3200
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Subtotal (Total Children Is Unduplicated) 245 559 1393.835692 $69706.5500 $50.0100
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Total 566 1396.857915 $69760.5300 $49.9400
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Number of Children (Unduplicated) With at Least One Authorization 250