Summary Report for FSPSAs Initiated During the Report Period Center: 04
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 599 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 23 23 15.422222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 23 23 15.422222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.466667 $22.6400 $48.5000
OCTH -97167TL OT EVAL HIGH COMPLEXITY 3 3 1.016666 $59.0700 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.661111 $38.4200 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 0.588889 $34.2200 $58.1100
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Subtotal (Total Children Is Unduplicated) 7 8 2.733333 $154.3500 $56.4700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 68 22.872224 $1143.6200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 3 1.416666 $70.8300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 1.811111 $90.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 1.811111 $90.5600 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 32.857142 $887.1400 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 89 91 759.428563 $41009.1400 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 377 388 3137.992025 $37655.9200 $12.0000
OCCT -97530TL OT SESSION BY LICENSED OT 4 4 36.285714 $2950.7500 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 3 3 36.000000 $2927.5300 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 25.285714 $2056.2400 $81.3200
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Subtotal (Total Children Is Unduplicated) 410 568 4055.760270 $88882.2900 $21.9200
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Total 599 4073.915825 $89036.6300 $21.8600
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Number of Children (Unduplicated) With at Least One Authorization 433