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 550 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
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 5.000000 $290.5500 $58.1100
SCREEN-T1023 SCREENING 3 3 3.000000 $161.9400 $53.9800
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.666667 $96.8500 $58.1100
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Subtotal (Total Children Is Unduplicated) 11 11 11.666667 $665.5600 $57.0500
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 -T1027SC EI INDIVIDUAL SESSION BY EI PROF 28 28 104.152379 $5624.2200 $54.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 25.047619 $2036.8700 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 3 3 4.504762 $366.3200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 2 2 12.428571 $809.3500 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 24.628571 $2002.8000 $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) 234 529 1412.864287 $72652.8200 $51.4200
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Total 550 1432.175399 $73318.3800 $51.1900
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Number of Children (Unduplicated) With at Least One Authorization 248