Summary Report for FSPSAs Ending During the Report Period Center: 09
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: 10-01-25 and 12-31-25 Date of Report: 01-07-26 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1441 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 22 23 28.544444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 23 28.544444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 12 14 66.509522 $3325.4700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 6 32.999999 $1650.0100 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 2.000000 $116.2200 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 6.142857 $356.9600 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $116.2200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 18.285714 $1062.5800 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 3.571428 $207.5300 $58.1100
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Subtotal (Total Children Is Unduplicated) 24 28 131.509520 $6834.9900 $51.9700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 136 211 276.724983 $13836.2500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 71 80 88.252446 $2206.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 101 106 109.219025 $5460.9600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 46 47 54.815873 $2740.7900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.444444 $36.1100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 41 38.392476 $1919.6300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 56 56 51.402740 $2570.1400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 614 673 4020.276167 $217095.0400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 54 57 310.301582 $25233.7400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 6 7 35.285714 $2297.8100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 34 37 211.828572 $17225.8700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 2 2 13.142857 $855.8700 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 58 66 304.579448 $24768.4000 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 7.285714 $474.4400 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 7.285714 $474.4400 $65.1200
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Subtotal (Total Children Is Unduplicated) 663 1390 5533.237755 $317270.7900 $57.3400
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Total 1441 5693.291719 $324105.7900 $56.9300
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Number of Children (Unduplicated) With at Least One Authorization 684