Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 1174 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 13 13 10.111111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 13 10.111111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 13 13 13.000000 $755.4300 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 7.000000 $406.7700 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 4.866667 $282.8000 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
SCREEN-T1023 SCREENING 18 19 19.000000 $1025.6200 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 6 7 10.466667 $608.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 6.857143 $398.4700 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $174.3300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 15 15 64.190478 $3730.1200 $58.1100
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Subtotal (Total Children Is Unduplicated) 70 77 130.380955 $7497.9800 $57.5100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 4.133333 $206.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 207 241 620.450002 $31022.5100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 114 125 315.300002 $15765.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.733333 $68.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 55 65 184.533335 $9226.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 109 115 282.466671 $14123.3600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 7.433333 $185.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 335 351 1679.971445 $90718.4500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 2.000000 $108.0000 $54.0000
INTR -T1013 INTERPRETER 1 1 13.000000 $650.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 46 49 158.723812 $12907.4400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 5 5 25.190476 $1640.4100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 40 46 180.940479 $14714.0700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 8 8 42.214286 $2749.0000 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 65 68 240.576193 $19563.6600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.933333 $75.9000 $81.3200
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Subtotal (Total Children Is Unduplicated) 454 1084 3761.600033 $213775.2900 $56.8300
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Total 1174 3902.092099 $221273.2700 $56.7100
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Number of Children (Unduplicated) With at Least One Authorization 489