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
Eligibility Filter: Program Patients
With the filters selected there were 1144 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 11 11 4.355556 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 11 4.355556 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 9.000000 $522.9900 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 7 7.000000 $406.7700 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 6.666667 $387.4000 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
SCREEN-T1023 SCREENING 17 17 17.000000 $917.6600 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 7.666667 $445.5100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 4.000000 $232.4400 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $174.3300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 17 17 85.012698 $4940.0900 $58.1100
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Subtotal (Total Children Is Unduplicated) 67 72 143.346032 $8259.6400 $57.6200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 5.116667 $255.8400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 192 225 574.833331 $28741.6600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 3.066667 $153.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 132 145 409.900000 $20495.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 63 171.922219 $8596.1000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 102 106 280.588890 $14029.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 19.633333 $490.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 317 332 1616.866669 $87310.8100 $54.0000
INTR -T1013 INTERPRETER 2 2 2.428571 $121.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 51 52 241.776188 $19661.2400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 7 8 26.095238 $1699.3300 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 8.000000 $520.9600 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 41 43 104.528570 $8500.2700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 6 6 33.990476 $2213.4500 $65.1200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 59 64 201.541269 $16389.3300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.200000 $422.8600 $81.3200
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Subtotal (Total Children Is Unduplicated) 406 1061 3707.488088 $209881.4900 $56.6100
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Total 1144 3855.189676 $218141.1300 $56.5800
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Number of Children (Unduplicated) With at Least One Authorization 439