Summary Report for FSPSAs Initiated During the Report Period Center: 52
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 298 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 8 8 6.266667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 6.266667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
SCREEN-T1023 SCREENING 1 1 1.000000 $53.9800 $53.9800
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.666667 $96.8500 $58.1100
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Subtotal (Total Children Is Unduplicated) 2 2 2.666667 $150.8300 $56.5600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 5.516667 $275.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 99 115 281.533335 $14076.6800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 61 65 155.933332 $7796.6600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 34 41 122.900001 $6145.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 42 42 106.033332 $5301.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 5.600000 $140.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11 11 12.985713 $701.2200 $54.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 14.714286 $1196.5700 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 1 1 0.933333 $75.9000 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 15.676191 $1274.8000 $81.3200
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Subtotal (Total Children Is Unduplicated) 129 288 723.826190 $37084.3200 $51.2300
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Total 298 732.759524 $37235.1500 $50.8100
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Number of Children (Unduplicated) With at Least One Authorization 138