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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4032 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 49 51 86.933334 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.011111 $0.4100 $37.1600
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Subtotal (Total Children Is Unduplicated) 50 52 86.944445 $0.4100 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 9 12.720700 $954.0500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.022222 $151.6700 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 10.000000 $750.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 4 4 6.005479 $450.4100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 0.005556 $0.4200 $75.5900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 20 29.866666 $1657.6000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 11 11 18.505479 $1027.0600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 74 75 145.005479 $10875.4100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 56 56 108.500000 $8137.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 11.500000 $862.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 47 47 93.000000 $6975.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 61 61 119.500000 $8962.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 28 28 55.000000 $4125.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 84 84 175.148336 $9720.7400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 81 82 160.000000 $8880.0000 $55.5000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 4 0.772223 $39.7000 $51.4200
OCTH -97165 OT EVAL LOW COMPLEXITY 34 36 19.418416 $998.3000 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.394444 $20.2800 $51.4000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 3.744445 $192.5000 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 0.972222 $49.9800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 16 17 5.005325 $257.3100 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 2 2.000000 $102.8200 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 5 5 1.399544 $71.9500 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 2.000000 $102.8200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 31 32 28.661111 $1473.4700 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.888889 $45.7000 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.066667 $3.4300 $51.4300
PSTH -97163 PT EVAL HIGH COMPLEXITY 8 8 5.266667 $270.7600 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 5 5 3.561111 $183.0800 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 29 31 25.813546 $1327.0700 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 1.063014 $54.6500 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 1.938888 $99.6700 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 37 38 22.290944 $1145.9800 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $26.2800 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 3.727778 $191.6500 $51.4100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 11.857143 $609.5700 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 7 37.571429 $1931.5500 $51.4100
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Subtotal (Total Children Is Unduplicated) 395 725 1157.215945 $74914.5200 $64.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 24 113.646967 $568235.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 54 64 62.277777 $3113.8900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 21 26 23.894444 $1194.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 529 641 1049.224495 $52461.2100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 148 172 290.388100 $14519.4100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 202 241 310.334527 $15516.7300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 143 166 275.119845 $13756.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.142857 $53.5700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 173 209 288.921830 $14446.1000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 74 89 132.025798 $6601.3000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 279 333 529.255158 $26462.7100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 139 160 239.435317 $11971.7400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 10.855555 $271.3900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 11 12.366668 $309.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 21 23 171.785714 $8589.3000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 534 658 4768.669857 $238433.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 108 123 875.801590 $43790.1300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 86 573.423812 $41263.6200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 4 6 33.368255 $2401.1900 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 73 92 633.138096 $45560.6200 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 7 7 46.785714 $3366.7100 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 4 4 19.142858 $1377.5200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 13.142857 $945.7600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 84 98 677.309532 $48739.2300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 8 8 53.357144 $3839.5800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 3.000000 $215.8800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.142857 $442.0400 $71.9600
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Subtotal (Total Children Is Unduplicated) 704 3255 11229.100481 $1168849.5100 $104.0900
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Total 4032 12473.260871 $1243764.4400 $99.7100
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Number of Children (Unduplicated) With at Least One Authorization 871