Summary Report for FSPSAs Initiated During the Report Period Center: 03
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: 10-01-25 and 12-31-25 Date of Report: 01-07-26 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 872 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 85 85 45.731748 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 85 85 45.731748 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 12 8.344445 $404.7100 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $31.8100 $31.8100
OCTH -97167 OT EVAL HIGH COMPLEXITY 41 47 34.244447 $1989.9600 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 32 36 18.944443 $1100.8500 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 57 64 51.891264 $3015.3700 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 122 160 114.424599 $6542.7100 $57.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 11 9.402740 $47013.5000 $4999.9800
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 7.955556 $397.7800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 50 53 81.544441 $4077.2100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 40 46 63.577779 $3178.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 35 36 47.422223 $2371.1200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 286 331 1832.801550 $98971.3800 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 38 47 312.887300 $25444.0000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 33 36 213.352377 $17349.8300 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 55 60 330.080949 $26842.2100 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 411 627 2899.024915 $225645.9200 $77.8400
-------------------------------------------------------------------------------------------------------------------------------------
Total 872 3059.181262 $232188.6300 $75.9000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 502