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
Eligibility Filter: Program Patients
With the filters selected there were 2344 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 21 21 34.061904 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 21 34.061904 $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 16 17 58.950249 $2947.5200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 25.219047 $1260.9500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 9 10 54.142857 $3146.2400 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 6 7 51.142857 $2971.9100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 18 21 207.847618 $12078.0200 $58.1100
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Subtotal (Total Children Is Unduplicated) 50 62 400.302628 $22582.5700 $56.4100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 210 327 430.421330 $21521.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 115 133 144.106121 $3602.6500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 175 182 190.782236 $9539.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 73 76 95.758729 $4787.9400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 76 80 88.760514 $4438.0300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 94 96 95.489561 $4774.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.011111 $75.2800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 857 931 6380.233472 $344532.8400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 108 115 834.016652 $67822.3100 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 8 8 71.857141 $4679.3400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 105 111 912.216658 $74181.4500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 6 6 42.142856 $2744.3500 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 173 190 1464.205623 $119069.2200 $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) 1009 2261 10768.573432 $662741.9400 $61.5400
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Total 2344 11202.937964 $685324.5000 $61.1700
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Number of Children (Unduplicated) With at Least One Authorization 1028