Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4172 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 1 1 0.084932 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.084932 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 39 57 43.334095 $2101.7100 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $14.5800 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.533333 $59.5300 $23.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.494444 $24.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 76 76 88.026353 $4401.3300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 3 6.000000 $333.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 20.000000 $1500.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 2.500000 $187.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.500000 $187.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 25 26 53.000000 $2941.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 13 14 29.000000 $2175.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.183333 $9.3600 $51.0400
OCTH -97165 OT EVAL LOW COMPLEXITY 4 5 5.000000 $255.2500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 4 1.594444 $81.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.316667 $67.2200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 1.722222 $87.9200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 6.000000 $306.3000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 5.427777 $277.0800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 12.398413 $552.3500 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 0.432877 $19.2900 $44.5500
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Subtotal (Total Children Is Unduplicated) 163 232 287.463958 $15885.6800 $55.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 10 5.076712 $25383.5000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.166667 $108.3400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $68.8600 $68.8600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 62 62 68.268538 $3413.4300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 7 8 11.500000 $575.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 5.822223 $145.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 463 662 1517.567114 $75878.6000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 3 3 10.847620 $542.3900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.800000 $45.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 233 299 622.614311 $31130.8300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 36 40 102.885718 $5144.3100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.133333 $153.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 66 166.307944 $8315.4300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 5 7.266666 $181.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 404 521 1095.167504 $54758.5900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 11 13 27.466668 $1373.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 9.233334 $230.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 97 120 885.422218 $44271.1500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 2.285714 $114.2900 $50.0000
INTR -T1013 INTERPRETER 17 27 109.483821 $5474.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 474 997 6009.295244 $60093.0600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 68.999999 $4929.3700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.428571 $310.5200 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 10.857143 $775.6300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 4 27.285714 $1949.3000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 10.857143 $775.6300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 5.428571 $310.3000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 2.285714 $130.6500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 17 140.714285 $10052.6500 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 11.714286 $162.5900 $13.8800
TRAV -TRAVS Travel by mile 475 1052 305364.641028 $135887.2700 $0.4500
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Subtotal (Total Children Is Unduplicated) 560 3939 316328.966660 $473624.5200 $1.5000
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Total 4172 316616.515550 $489510.2000 $1.5500
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Number of Children (Unduplicated) With at Least One Authorization 580