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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4436 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 6 6 6.177778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 6 6.177778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 53 62 38.175418 $1851.5300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.252055 $14.1400 $56.1100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 4 1.763166 $25.8800 $14.6800
EXIT -EXIT COS Exit 7 7 5.616667 $280.8400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.500000 $187.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 1.500000 $112.5000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 11.521916 $864.1500 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 3.000000 $225.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 19 25 41.521916 $2304.4700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 7 12.500000 $937.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 3 0.754947 $38.8100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 10 11 26.335921 $1353.9300 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 10 18.930605 $973.2200 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.038356 $1.9700 $51.4700
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 2 0.511111 $26.2800 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 3 2.405480 $123.6700 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 15.165079 $779.6400 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 1.243836 $63.9500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 10 11 5.267885 $270.8200 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.246575 $12.6800 $51.4200
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.054795 $2.8200 $51.4200
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.252055 $12.9600 $51.4200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.511111 $180.5100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.136986 $7.0400 $51.4200
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.038356 $1.9700 $51.4700
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 2.000000 $102.8200 $51.4100
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Subtotal (Total Children Is Unduplicated) 103 187 211.244236 $11839.6000 $56.0500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 22 58.368821 $291845.0000 $5000.0200
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 69 73 88.713042 $4435.6800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 10 10 11.263889 $563.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 4.574999 $114.3700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 446 592 1345.781786 $67289.3000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 4 7.666666 $383.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.633333 $65.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 266 334 704.816359 $35240.9100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 2.366666 $118.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 13.800000 $345.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 27 59.076519 $2953.8400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 4.100001 $102.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 420 514 1112.522257 $55626.2900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 3.066667 $153.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 25.152382 $628.8100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 7 88.714286 $4435.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 105 129 1038.482536 $51924.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 19 20 169.066668 $8453.3500 $50.0000
INTR -T1013 INTERPRETER 20 33 102.057989 $5102.9100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 466 1098 6016.422978 $72197.2000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 23 27 209.939684 $15107.2600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 14 16 158.571428 $11410.8100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 19 145.082541 $10440.1400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.857143 $205.6000 $71.9600
TRAV -TRAVS Travel by mile 510 1285 349034.011617 $155320.1400 $0.4500
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Subtotal (Total Children Is Unduplicated) 555 4243 360410.110257 $794532.3700 $2.2000
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Total 4436 360627.532271 $806371.9700 $2.2400
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Number of Children (Unduplicated) With at Least One Authorization 568