Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5228 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 31 31 46.149207 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 31 31 46.149207 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 26 26 59.100794 $4432.5700 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 8 8 13.005479 $975.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 4.005479 $300.4100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 8 8 12.005479 $900.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 121 122 226.658111 $12579.5300 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 15 15 15.585845 $865.0100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 49 49 85.590411 $6419.2800 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 78 78 124.180972 $9313.5800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 28 28 52.000000 $3900.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 21 21 28.008219 $2100.6200 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 100 101 163.164383 $12237.3200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 81 83 137.658903 $7640.0700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 50 50 83.021917 $4607.7200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 10 4.333332 $221.2100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 85 89 69.150739 $3530.1500 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 6 6 3.253652 $166.1000 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.316667 $16.1700 $51.0600
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 9 9 17.878245 $912.6900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 3.000000 $153.1500 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.005556 $0.2900 $51.4600
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 17 18 7.633333 $389.6800 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 3 3 0.800000 $40.8400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 76 82 63.735010 $3253.6800 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 0.607610 $31.0200 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 6 6 1.496880 $76.4200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 3.000000 $153.1500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 147 152 79.983172 $4083.1600 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 11 11 8.072221 $412.0800 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 15 16 7.534018 $384.6100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 5 6 5.094444 $260.0700 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.327778 $16.7300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 25 25 20.113167 $896.0400 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 1.511720 $67.3500 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 582 1065 1340.000126 $84018.8900 $62.7000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 27 29 35.003958 $175020.5000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 36 41 52.900829 $2645.0500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 30 36 40.020635 $2001.0400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 3.066667 $76.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 586 719 1056.193912 $52809.8100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 96 103 128.416676 $6420.8800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 211 248 350.916665 $17545.8300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 34 37 60.907142 $3045.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 7.117460 $177.9400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 235 282 395.685643 $19784.3600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 59 67 96.537305 $4826.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.516667 $12.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 480 573 819.573421 $40978.7000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 88 93 164.070640 $8203.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 6.144444 $153.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 626 782 6041.950752 $302098.0100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 192 216 1584.132452 $79206.7400 $50.0000
INTR -T1013 INTERPRETER 2 3 26.285714 $1314.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 145 170 1395.045235 $99662.1200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 17 17 87.557937 $6255.1400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 29.000000 $1658.8000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 13.142857 $751.7700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 4 4 40.000000 $2857.6100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 25 27 209.517462 $14967.9200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 132 167 1257.919042 $89865.8300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 16 18 115.288096 $8236.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 11 11 99.428571 $5683.3400 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 5 7 37.847620 $2703.8400 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 26 28 248.928571 $17783.4700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 259 303 2106.223450 $150468.8000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 39 42 196.603620 $14045.3700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 10.857143 $621.0300 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 5.000000 $286.0000 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 9 9 82.714285 $5909.1200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 35 37 266.038094 $19005.7800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 23 24 201.852380 $2801.7100 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 13.428571 $186.3900 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 15 16 32.966668 $1219.7700 $37.0000
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Subtotal (Total Children Is Unduplicated) 791 4132 17318.800584 $1161292.0900 $67.0500
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Total 5228 18704.949917 $1245310.9800 $66.5800
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Number of Children (Unduplicated) With at Least One Authorization 895