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 2869 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 40 41 69.128573 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 40 41 69.128573 $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 6 6 8.233334 $617.5100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 5 5 6.188889 $464.1700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 2.016590 $151.2500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 16 16 30.116667 $1671.4800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 6.005479 $333.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 19 19 38.000000 $2850.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 30 30 52.060275 $3904.5200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 13 13 26.966667 $2022.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 7 7 14.966667 $1122.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 26 26 42.358904 $3176.9000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 28 28 54.000000 $2997.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 32 32 48.436530 $2688.2100 $55.5000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.716667 $35.8400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 7 4.398706 $224.5600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 1.274277 $65.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 4.272222 $218.1000 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
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Subtotal (Total Children Is Unduplicated) 128 218 355.522985 $23511.2200 $66.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 4.628919 $23144.5000 $4999.9800
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 586 714 1161.681771 $58084.1700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 92 104 203.265879 $10163.3000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 310 368 612.975015 $30648.8000 $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 184 219 1750.580943 $87529.2300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 21 24 200.492856 $10024.6600 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 7 48.104761 $3436.6100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 7 7 42.714286 $3051.5000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 20.357143 $1454.3200 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 6.571429 $243.1400 $37.0000
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Subtotal (Total Children Is Unduplicated) 756 2610 5864.727387 $318394.8900 $54.2900
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Total 2869 6289.378945 $341906.1100 $54.3600
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Number of Children (Unduplicated) With at Least One Authorization 836