Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 3030 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 122 126 6163.577776 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 23 23 5801.672222 $215822.2100 $37.2000
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Subtotal (Total Children Is Unduplicated) 144 149 11965.249998 $215822.2100 $18.0400
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 0.622223 $31.1200 $50.0100
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 4 7.000000 $350.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 2.109590 $158.2200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 39 39 78.000000 $5850.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 8 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 17 17 34.000000 $2550.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 45 45 90.000000 $4995.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 21 21 42.000000 $2331.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
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 22 26 8.605556 $442.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.327778 $16.8500 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 9 2.977779 $153.0900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 38 39 26.590488 $1367.0200 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 2.022222 $103.9600 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 18 19 5.994443 $308.1700 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.022222 $1.1400 $51.3600
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.111111 $5.7100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 3.783333 $194.5000 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 13 8.372222 $430.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 9 9 4.283333 $220.2000 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 48 55 21.711108 $1116.1500 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $26.2800 $51.4100
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Subtotal (Total Children Is Unduplicated) 225 350 406.555630 $25483.9300 $62.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 7.550000 $37750.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 34 35 28.376388 $1418.8200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 2 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 9 10.683334 $267.0900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 368 447 325.532527 $16276.5600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 4 4 2.966666 $148.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 170 199 274.216671 $6855.4300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 248 459 318.755545 $15937.7300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 6 5.044444 $252.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 82 185 253.149986 $6328.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 68 158 102.444436 $5122.1800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 29 64 113.642860 $2841.0800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 270 310 221.050781 $11052.4800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 5 5 4.233332 $211.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 175 206 261.483335 $6537.0900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 137 166 1417.447619 $70872.4700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 6 36.533334 $1826.6600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 54 403.732542 $29052.5800 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 40 46 505.285714 $29104.4700 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 3 4 23.142857 $1333.0300 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 4.857143 $349.5200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 31 37 313.707939 $22574.4100 $71.9600
PHY -97110HM PT SESSION BY PT ASST 21 26 197.197620 $11350.7000 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 13.142857 $756.5100 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.544444 $125.0000 $229.5900
SENS -V5264 EARMOLD 1 2 2.044444 $37.0600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 73 87 790.071430 $56853.5900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 23.571428 $1696.2100 $71.9600
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Subtotal (Total Children Is Unduplicated) 645 2531 5675.552533 $337977.3200 $59.5500
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Total 3030 18047.358161 $579283.4600 $32.1000
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Number of Children (Unduplicated) With at Least One Authorization 802