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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4502 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 3 4 8.133333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 4 8.133333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 58 73 44.692922 $2167.6200 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 3.000000 $44.0400 $14.6800
EXIT -EXIT EXIT ASSESSMENT 40 40 45.002740 $2250.1400 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 17.510958 $1313.3300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 10 11 21.000000 $1575.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 36 36 63.016437 $3497.4200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 15 15 29.500000 $1637.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 19.500000 $1462.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 2 3.066666 $153.3300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 5 1.560807 $80.2400 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 7 10 7.644444 $393.0000 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 2.202740 $113.2400 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.186301 $9.5800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.088889 $4.5700 $51.4200
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 3 0.949011 $48.7900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 3.735388 $192.0400 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 2.000000 $102.8200 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.186301 $9.5800 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 8 10 7.377549 $379.2800 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.071233 $3.6600 $51.3900
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.473973 $24.3600 $51.4000
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.186301 $9.5800 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.011111 $0.5700 $51.3600
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Subtotal (Total Children Is Unduplicated) 167 260 297.963771 $17245.3200 $57.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 13 27.052587 $135262.5000 $4999.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.085388 $54.2700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 39 44 63.599710 $3179.9900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 4 4.505556 $225.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 6.133334 $153.3400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 429 590 1204.066707 $60203.5400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 2.633333 $131.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 199 256 515.594929 $25779.8300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 3.300000 $165.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.133334 $153.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 47 60 112.292859 $5614.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 388 494 960.257178 $48013.0300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 4 5 9.566667 $478.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 12.000000 $300.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 16 17 102.233334 $5111.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 95 114 931.795242 $46589.7900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 9 76.571429 $3828.5800 $50.0000
INTR -T1013 INTERPRETER 23 38 140.898337 $7044.9200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 492 1210 6410.962656 $64109.7100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 16 107.714285 $7751.1300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 11 13 138.000000 $9930.4900 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 14 113.428571 $8162.3400 $71.9600
TRAV -TRAVS Travel by mile 507 1323 337119.172263 $150018.0300 $0.4500
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Subtotal (Total Children Is Unduplicated) 556 4238 348070.997699 $582400.1000 $1.6700
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Total 4502 348377.094803 $599645.4300 $1.7200
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Number of Children (Unduplicated) With at Least One Authorization 580