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 2716 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 84 88 128.834919 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 84 88 128.834919 $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 3 3 4.115068 $308.6300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 4.010958 $300.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 4 4 4.005479 $300.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 13.571429 $753.2100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 8 13.505479 $749.5600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 16 16 30.500000 $2287.5000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 30 31 52.016437 $3901.2400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 9 9 16.005479 $1200.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 16.500000 $1237.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 28 29 46.519177 $3488.9400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 32 32 59.965753 $3328.1000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 38 39 62.030135 $3442.6800 $55.5000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.600000 $30.8500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.250000 $12.8500 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.377778 $19.4200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.093151 $4.7900 $51.4400
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 3.000000 $154.2300 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.072222 $3.7100 $51.3900
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.250000 $12.8500 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 3.038889 $156.2300 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.061111 $3.1400 $51.4000
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 117 219 349.499656 $22958.5400 $65.6900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 2.383562 $11918.0000 $5000.0800
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 530 645 945.936119 $47296.8100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 151 177 269.457144 $13472.8500 $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 12 13 101.519047 $5075.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 160 197 1271.433337 $63571.6900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 25 25 143.450004 $7172.4900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3 4 27.285714 $272.8600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 4.357143 $313.5400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 4 4 14.857144 $1069.1100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 10 48.928572 $3520.9100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 4 27.214286 $1958.3400 $71.9600
TRAV -TRAVS Travel by mile 2 2 58.142857 $25.8700 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 662 2409 4824.750649 $250444.8900 $51.9100
-------------------------------------------------------------------------------------------------------------------------------------
Total 2716 5303.085224 $273403.4300 $51.5600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 768