Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 2606 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 123 138 82.503163 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 123 138 82.503163 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.511111 $24.7900 $48.5000
OCTH -97165TL OT EVAL LOW COMPLEXITY 2 2 0.900000 $52.3000 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.194444 $11.3000 $58.1000
OCTH -97167TL OT EVAL HIGH COMPLEXITY 12 13 4.494445 $261.1800 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 21 22 7.950000 $461.9700 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 18 20 5.744445 $333.8100 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.022222 $59.4000 $58.1100
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Subtotal (Total Children Is Unduplicated) 38 61 20.816667 $1204.7500 $57.8700
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 53 156 47.533330 $2376.6500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 13 14 8.477779 $423.9000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 12 13 7.009523 $350.4800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.555556 $13.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 2.244445 $112.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 2.122223 $106.1200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.022222 $51.1100 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 15 15 50.428571 $1361.5800 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 11.857143 $592.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 349 433 3753.860309 $202708.7200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 0.714286 $38.5700 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1329 1697 14718.847603 $176626.3800 $12.0000
OCCT -97530TL OT SESSION BY LICENSED OT 15 17 123.285714 $10025.6300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 15.714286 $1277.8900 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 19 21 123.285716 $10025.6200 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 21 23 135.142860 $10989.8400 $81.3200
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Subtotal (Total Children Is Unduplicated) 1408 2407 19004.101566 $417544.6800 $21.9700
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Total 2606 19107.421396 $418749.4300 $21.9200
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Number of Children (Unduplicated) With at Least One Authorization 1503