Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 2925 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 34 38 2804.766666 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 1363.000000 $50431.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 42 46 4167.766666 $50431.0000 $12.1000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 35 37 47.729755 $2386.4900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 6.011111 $300.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 78 78 144.344444 $7217.2200 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 28.000000 $2100.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 6 6 10.066667 $755.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 16 16 32.000000 $1776.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 3 6.000000 $450.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 7 9 2.827777 $144.3500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 1.205556 $61.5500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 6.238889 $318.5000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 1.666666 $85.0800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.094444 $4.8200 $51.0300
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 2.061111 $105.2200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.400000 $20.4200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 9 10 4.888888 $249.5700 $51.0500
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Subtotal (Total Children Is Unduplicated) 175 218 327.540787 $18330.0800 $55.9600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.450000 $12250.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 2.333333 $116.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 2.533333 $126.6700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.800000 $414.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 7 19.165079 $958.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 11 6.655558 $166.4000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 317 413 323.664281 $16183.1900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 1.288889 $64.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 279 359 444.376191 $11109.4100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 199 437 282.824590 $14141.1700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 0.188889 $9.4500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 124 265 282.911109 $7072.7700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 53 132 104.838090 $5241.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 47 117 137.055554 $3426.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 276 341 270.877774 $13543.8700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.388889 $19.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 265 332 382.627783 $9565.7100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 6 59.714285 $1492.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 112 137 1172.857132 $58642.9500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 15 79.357142 $3967.8600 $50.0000
INTR -T1013 INTERPRETER 2 2 3.000000 $150.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 18 131.142855 $9368.8600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 12 14 141.857141 $8114.2400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2 2 9.285714 $663.3700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 6 68.142856 $3895.0500 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 4.044444 $1844.2500 $456.0000
SENS -V5264 EARMOLD 3 3 1.800000 $32.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 26 204.571426 $14614.6200 $71.4400
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Subtotal (Total Children Is Unduplicated) 593 2661 4141.752337 $197196.1500 $47.6100
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Total 2925 8637.059790 $265957.2200 $30.7900
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Number of Children (Unduplicated) With at Least One Authorization 690