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
Eligibility Filter: Program Patients
With the filters selected there were 2498 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 29 30 43.615873 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 30 43.615873 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $61.7100 $61.7100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 22 26 126.480950 $6324.0400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 13 13 71.285713 $3564.2900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 2.000000 $116.2200 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 6 7 12.285714 $713.9300 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 10.428571 $606.0100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 10.428571 $606.0100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 2.142857 $124.5200 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 12 13 25.999999 $1510.8700 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 18.285714 $1062.5800 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 18 20 178.933333 $10397.8000 $58.1100
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Subtotal (Total Children Is Unduplicated) 68 88 459.271422 $25087.9700 $54.6300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 228 362 509.972144 $25498.6000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 110 125 133.648043 $3341.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 164 170 167.415059 $8370.7700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 81 82 85.280159 $4264.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.444444 $36.1100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 59 62 58.760731 $2938.0500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 93 93 84.447185 $4222.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.000000 $50.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 907 990 5954.423777 $321539.0000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 124 136 887.971639 $72209.8600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 6.428571 $522.7700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 10 11 70.142857 $4567.7000 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 126 136 891.159524 $72469.0700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 5 6 35.428571 $2307.1100 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 180 198 1152.593726 $93728.9600 $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) 1080 2380 10057.687858 $617064.4500 $61.3500
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Total 2498 10560.575153 $642152.4200 $60.8100
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Number of Children (Unduplicated) With at Least One Authorization 1108