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 426 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 2 2 2.333333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 2.333333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 24.357143 $1217.8600 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 5.142857 $257.1500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $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) 8 8 34.071428 $1740.6400 $51.0900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 63 93 149.889823 $7494.4900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 8 9.095890 $227.4000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 44 44 41.553968 $2077.7000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 23 23 21.588889 $1079.4500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 13 12.088889 $604.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 29 29 26.533333 $1326.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 141 153 929.409521 $50188.1200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 18 91.392856 $7432.0700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 3 16.285714 $1060.5300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 13 15 77.100001 $6269.7600 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 16 16 83.499999 $6790.2100 $81.3200
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Subtotal (Total Children Is Unduplicated) 230 416 1459.438883 $84575.8300 $57.9500
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Total 426 1495.843644 $86316.4700 $57.7000
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Number of Children (Unduplicated) With at Least One Authorization 233