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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4668 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 44 45 73.789684 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 44 45 73.789684 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 14 14 21.516667 $1613.7500 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 7 7 6.211111 $465.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 9 9 6.189497 $464.2100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 57 59 107.934531 $5990.3600 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 7 7 8.235616 $457.0800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 44 45 89.000000 $6675.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 83 84 125.766257 $9432.4400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 38 38 75.966667 $5697.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 4 4 7.000000 $525.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 21 22 40.966667 $3072.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 88 88 136.322115 $10224.1300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 73 74 141.642857 $7861.1800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 98 98 152.795435 $8480.1200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 2.002740 $150.2000 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.716667 $35.8400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 9.000000 $459.4500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 18 18 7.605555 $388.2600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 91 95 74.115079 $3783.5800 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.500000 $25.5300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.0900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 18 20 9.661110 $493.1900 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.127778 $6.5200 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 54 55 58.351619 $2978.8400 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 9.900000 $505.4000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.194444 $9.9200 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 125 131 71.084928 $3628.8700 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.022222 $154.2800 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 3.774277 $192.6700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 10 10 5.966667 $304.6000 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.511111 $26.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 17 17 12.588887 $560.8300 $44.5500
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Subtotal (Total Children Is Unduplicated) 528 949 1214.181615 $76490.3200 $63.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 18 12.527550 $62638.0000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 58 66 72.561112 $3628.0600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 18 22 14.549999 $727.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 4.733333 $118.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 587 716 1164.981771 $58249.1700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 92 104 203.265879 $10163.3000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 311 369 614.608348 $30730.4600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 59 62 131.545241 $6577.2700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 2.711110 $67.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 214 252 387.230570 $19361.5900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 40 47 75.045238 $3752.2700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.800000 $45.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 471 562 873.987304 $43699.4900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 108 130 229.892065 $11494.5900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 4 4.155556 $103.8900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 579 708 5499.374576 $274969.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 64 71 502.216668 $25110.8500 $50.0000
INTR -T1013 INTERPRETER 2 2 4.000000 $200.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 3.000000 $30.0000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 123 150 1077.412699 $76970.4600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.142857 $81.6500 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 3 4 39.428572 $2816.7800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 9 10 84.495239 $6036.3500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 110 137 996.723814 $71205.9800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.000000 $285.7600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 13.461904 $769.4800 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 3 5 21.104762 $1507.7300 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 5 6 43.714286 $3122.9600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 155 185 1390.834530 $99361.2700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 7 38.719047 $2766.0900 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 10.442857 $746.0400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 13 14 103.457143 $7390.9800 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 14.000000 $194.3200 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 6.571429 $243.1400 $37.0000
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Subtotal (Total Children Is Unduplicated) 808 3674 13647.695459 $825165.7000 $60.4600
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Total 4668 14935.666758 $901656.0300 $60.3700
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Number of Children (Unduplicated) With at Least One Authorization 943