Summary Report for FSPSAs Initiated During the Report Period Center: 09
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 271 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
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 6.000000 $300.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 45.000000 $2614.9500 $58.1100
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Subtotal (Total Children Is Unduplicated) 6 7 53.000000 $3031.1700 $57.1900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 61 88.500000 $4425.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 8.000000 $200.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 30 31 31.304763 $1565.2400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 20 20.000000 $1000.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 5 5.000000 $250.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 15 15 15.000000 $750.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.000000 $50.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 83 93 573.685707 $30979.0200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 10 39.540476 $3215.4500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 7.000000 $455.8400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 8 8 70.171428 $5706.3400 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 12 100.142855 $8143.6300 $81.3200
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Subtotal (Total Children Is Unduplicated) 145 264 960.345229 $56740.5200 $59.0800
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Total 271 1013.345229 $59771.6900 $58.9800
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Number of Children (Unduplicated) With at Least One Authorization 145