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
Eligibility Filter: Program Patients
With the filters selected there were 1034 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 7.644445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 10 7.644445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 11 11 11.000000 $639.2100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 9.000000 $522.9900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 14 14 14.000000 $813.5400 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 4.000000 $232.4400 $58.1100
SCREEN-T1023 SCREENING 23 23 23.000000 $1241.5400 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 5.000000 $290.5500 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 5.000000 $290.5500 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 14 15 61.552380 $3576.8200 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 4.866667 $282.8000 $58.1100
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Subtotal (Total Children Is Unduplicated) 82 89 140.419047 $8064.7800 $57.4300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 5.516667 $275.8400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 175 198 482.600002 $24130.0100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 107 112 288.466666 $14423.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 65 76 232.600003 $11630.0200 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 2.000000 $100.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 85 85 215.600000 $10780.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 12.033333 $300.8300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 6.066667 $303.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 294 302 1346.030932 $72685.7100 $54.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 46 47 184.961902 $15041.1300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 4 4 21.085714 $1373.1000 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 3.000000 $195.3600 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 35 35 99.904762 $8124.2600 $81.3200
PHY -97110HM PT SESSION BY PT ASST 15 15 93.126188 $6064.3800 $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 44 44 167.171427 $13594.3800 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.285714 $23.2300 $81.3200
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Subtotal (Total Children Is Unduplicated) 401 935 3164.449977 $179424.5100 $56.7000
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Total 1034 3312.513469 $187489.2800 $56.6000
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Number of Children (Unduplicated) With at Least One Authorization 436