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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4202 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 86 90 132.323808 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 86 90 132.323808 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 11 11 16.449391 $1233.7100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 14 14 22.010958 $1650.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $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 7 7 9.005479 $675.4100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 19 29.938552 $1661.5900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 13 15 24.505479 $1360.0600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 36 37 72.500000 $5437.5000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 84 85 141.105174 $10582.8900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 14.500000 $1087.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 32 32 58.010958 $4350.8300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 24 24 45.500000 $3412.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 86 87 134.563010 $10092.2300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 94 94 180.532420 $10019.5500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 107 108 165.128763 $9164.6500 $55.5000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 24 24 13.513623 $694.7400 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 1.027778 $52.8400 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 3 3 1.594444 $81.9700 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 55 57 25.848857 $1328.8800 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 8 8 4.367274 $224.5200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 8 8 7.111111 $365.5800 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 11.693651 $601.1700 $51.4100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 0.238356 $12.2600 $51.4200
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.111111 $5.7100 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.077778 $4.0000 $51.4200
PSTH -97163 PT EVAL HIGH COMPLEXITY 30 30 22.444365 $1153.8500 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 5 6 2.490487 $128.0400 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.022222 $1.1400 $51.3600
SPCH -92521 EVAL OF SPEECH FLUENCY 29 32 25.587900 $1315.4700 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.072222 $3.7100 $51.3900
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.8200 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.511111 $26.2800 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 9 9 9.000000 $462.6900 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.250000 $12.8500 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 70 76 37.779373 $1942.2300 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.061111 $54.5500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.511111 $77.6900 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 8 5.585084 $250.5500 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 5 44.285714 $2344.0400 $52.9300
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Subtotal (Total Children Is Unduplicated) 452 852 1172.945978 $74841.1000 $63.8100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 16 12.756165 $63781.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 66 64.057935 $3202.8900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 26 30 31.474602 $1573.7300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 7.500000 $187.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 531 646 946.958341 $47347.9200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 152 178 270.479366 $13523.9600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.088889 $52.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 211 239 382.562715 $19128.2000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 74 80 120.103970 $6005.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.855556 $21.3900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 164 198 248.388095 $12419.4000 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 70 80 101.515076 $5075.7400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.466667 $61.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 382 449 666.329359 $33316.4300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 145 163 266.842856 $13342.1400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 15.600000 $390.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 30 34 268.376187 $13418.8400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 541 664 4831.680629 $241584.2100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 85 96 648.878576 $32443.9300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3 4 27.285714 $272.8600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 67 444.140477 $31960.3600 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.857143 $277.5600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 2 3 24.142857 $1737.3200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 7.285714 $524.2800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 66 79 563.128570 $40522.7300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 5 40.500000 $2914.3800 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 3 3 18.495239 $1330.9100 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 4 5 42.428573 $3053.1500 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 104 118 922.659524 $66394.6400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 7 43.461905 $3127.5200 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 5 40.500000 $2914.3800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 24.428572 $1757.8800 $71.9600
TRAV -TRAVS Travel by mile 2 2 58.142857 $25.8700 $0.4500
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Subtotal (Total Children Is Unduplicated) 719 3260 11149.372129 $663690.1800 $59.5300
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Total 4202 12454.641915 $738531.2800 $59.3000
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Number of Children (Unduplicated) With at Least One Authorization 889