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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2609 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 9.580952 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 61.333333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 7 70.914285 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 47 56 43.189637 $2094.7000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $123.4200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 1.061111 $16.1200 $15.1900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.283333 $4.5800 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $24.2800 $24.2800
EXIT -EXIT COS Exit 13 13 12.002740 $600.1400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 11.521916 $933.0500 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 8 8 14.005556 $1134.1700 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 8 14.000000 $1133.7200 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $971.7600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 22 22 35.021916 $2098.5200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 16 16 32.000000 $1917.4400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 20 27 50.000000 $4049.0000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 4 5 10.000000 $809.8000 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 8 8 10.714754 $622.6400 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.312405 $18.1500 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.030137 $1.7500 $58.0400
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.169863 $9.8700 $58.1200
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.311112 $18.0800 $58.1300
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 10 10 17.333801 $1007.2700 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.252055 $14.6500 $58.1200
SPCH -92522 EVAL OF SPCH SOUND PROD 3 4 5.938552 $345.0900 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.106849 $6.2100 $58.0800
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.205556 $128.1700 $58.1100
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Subtotal (Total Children Is Unduplicated) 128 212 278.461293 $18290.6800 $65.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 11.429365 $57146.5000 $4999.9700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 83 87 107.475691 $5373.7800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 16 16 20.316667 $1015.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 440 603 1289.247645 $64462.5200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 9 11 20.233334 $1011.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.100000 $27.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 253 310 654.099693 $32705.0800 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 6.200000 $310.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.133333 $153.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 10 16.633333 $831.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 6 12.266667 $306.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 396 494 1050.276212 $52513.9200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.233333 $111.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 10 19.442857 $486.0700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 125 157 1233.342859 $66600.6000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 10 11 88.142858 $4759.7200 $54.0000
INTR -T1013 INTERPRETER 26 38 114.271915 $5713.6100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 124 268 1131.976189 $13583.7300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 14 95.285716 $7748.6300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 6 6 40.428572 $3287.6500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 2 13.142857 $855.8700 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 23 167.716049 $13638.6800 $81.3200
TRAV -TRAVS Travel by mile 125 310 61893.354872 $27542.5400 $0.4500
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Subtotal (Total Children Is Unduplicated) 527 2390 67994.750017 $360187.2200 $5.3000
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Total 2609 68344.125595 $378477.9000 $5.5400
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Number of Children (Unduplicated) With at Least One Authorization 566