Summary Report for FSPSAs Ending During the Report Period Center: 52
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 350 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 10 10 4.088889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 10 4.088889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $116.2200 $58.1100
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Subtotal (Total Children Is Unduplicated) 3 3 3.000000 $174.3300 $58.1100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 5.116667 $255.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 118 139 353.700000 $17685.0000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 3.066667 $153.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 81 85 246.766668 $12338.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 34 37 84.955553 $4247.7700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 55 57 146.455556 $7322.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 16.233333 $405.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 7 29.080951 $1570.3700 $54.0000
INTR -T1013 INTERPRETER 2 2 2.428571 $121.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 10.428571 $848.0500 $81.3200
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Subtotal (Total Children Is Unduplicated) 135 337 898.232537 $44948.7400 $50.0400
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Total 350 905.321426 $45123.0700 $49.8400
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Number of Children (Unduplicated) With at Least One Authorization 147