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 2590 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
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Subtotal (Total Children Is Unduplicated) 49 51 86.933334 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 4 6.109589 $458.2200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $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 5 5 6.344444 $352.1100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 24 25 49.000000 $3675.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 13 13 23.500000 $1762.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.500000 $412.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 9 9 17.000000 $1275.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 15 15 29.000000 $2175.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 9 9 17.500000 $1312.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 23 23 45.000000 $2497.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 23 24 47.000000 $2608.5000 $55.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.388889 $71.4000 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.266667 $65.1200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.8200 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.711111 $87.9700 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 87 155 276.837367 $18432.4800 $66.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 96.142857 $480714.5000 $5000.0000
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 4 5 9.966668 $249.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 11 13 102.071428 $5103.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 151 187 1288.795246 $64439.8200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 36 40 301.387303 $15069.3800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 19.780954 $1423.4400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 5 5 17.742856 $1276.7800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 11 102.571429 $7381.0500 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $945.7600 $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) 635 2384 5172.620158 $737439.2700 $142.5700
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Total 2590 5536.390859 $755871.7500 $136.5300
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Number of Children (Unduplicated) With at Least One Authorization 713