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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2909 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 72 79 123.671430 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 72 79 123.671430 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.500000 $37.5000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 2.500000 $187.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $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 2 2 3.500000 $262.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 8 13.500000 $749.2500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 5.500000 $305.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 22.000000 $1650.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 39 39 74.505479 $5587.9100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 21 21 39.005479 $2925.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 11 11 19.500000 $1462.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 30 31 59.405479 $4455.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 35 35 65.500000 $3635.2500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 48 48 88.916437 $4934.8700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 1.850000 $95.1100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.266667 $13.7100 $51.4200
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.333333 $17.1400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 0.733333 $37.7000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 3 3.000000 $154.2300 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.158904 $8.1700 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.266667 $13.7100 $51.4200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 3.200000 $164.5100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.027778 $1.4300 $51.4500
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Subtotal (Total Children Is Unduplicated) 137 249 433.169556 $28803.2900 $66.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 4.246575 $21233.0000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 64 69 80.554762 $4027.7500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 29 36 41.454760 $2072.7400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 10.500000 $262.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 523 658 877.581734 $43879.0700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 147 174 250.096819 $12504.8300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 0.677778 $16.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 205 253 340.288887 $17014.4400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 126 148 219.247621 $10962.3900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.988889 $24.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 153 217 225.631743 $11281.5900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 74 107 97.883331 $4894.1600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 340 432 518.305150 $25915.2500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 155 190 247.991266 $12399.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 8.238889 $205.9700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 13 13 107.714285 $5385.7100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 151 196 1191.928566 $59596.4000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 19 114.077778 $5703.8700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4 5 28.285714 $282.8600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 8 46.357142 $3335.8600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 7 7 30.999999 $2230.7700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 3 12.857142 $925.2000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 11 48.214284 $3469.5100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 6.642857 $478.0200 $71.9600
TRAV -TRAVS Travel by mile 4 5 88.428571 $39.3500 $0.4400
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Subtotal (Total Children Is Unduplicated) 648 2581 4599.194542 $248142.4400 $53.9500
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Total 2909 5156.035528 $276945.7300 $53.7100
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Number of Children (Unduplicated) With at Least One Authorization 757