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: 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 4097 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 96 105 144.642860 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 96 105 144.642860 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 6.000000 $450.0000 $75.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 1.000000 $55.5000 $55.5000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 18.011111 $1458.5400 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 11 11 17.022222 $1378.4600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.011111 $0.9000 $80.9000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 3.500000 $283.4300 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 12 12 21.011111 $1701.4800 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 4.500000 $364.4100 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 20 20 28.511111 $1708.3900 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 21 22 32.022222 $1918.7700 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 80 82 160.000000 $12956.8000 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 74 74 144.000000 $11661.1200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $809.8000 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 14 14 26.000000 $2105.4800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 67 67 130.500000 $10567.8900 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 31 31 59.000000 $4777.8200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 80 80 152.000000 $9107.8400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 102 104 196.500000 $11774.2800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 10.000000 $809.8000 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 0.682115 $39.6400 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 24 29 11.144441 $647.5800 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.055556 $3.2300 $58.1600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 0.622223 $36.1600 $58.1200
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 18 19 11.672223 $678.2800 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 5 5 2.755556 $160.1300 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.344444 $20.0100 $58.1000
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 1.483333 $86.1900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 38 41 34.794445 $2021.9100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.022222 $59.4000 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 21.280832 $1236.6300 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.516666 $30.0200 $58.1000
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 1.105555 $64.2400 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 38 40 30.496498 $1772.1500 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.427778 $141.0800 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 41 46 27.954705 $1624.4400 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 3.733334 $216.9500 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.311111 $18.0800 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 2.000000 $116.2200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 7 6.405556 $372.2300 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 7 8 61.161904 $3554.1200 $58.1100
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Subtotal (Total Children Is Unduplicated) 428 796 1250.559385 $87358.1200 $69.8600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 43 49 58.922768 $294616.0000 $5000.0400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 66 49.111110 $2455.5500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 23 25 22.933334 $1146.6700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 465 612 857.448017 $42872.3300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 126 160 236.292062 $11814.5800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 138 169 196.122222 $9806.1000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 78 95 134.186510 $6709.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 202 248 364.256353 $18212.7900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 85 103 138.000008 $6900.0200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.022222 $25.5600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 306 361 460.811107 $23040.5000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 160 185 236.478570 $11823.9100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 9 11.899999 $297.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 21 21 66.414288 $1793.1900 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 501 657 4456.868270 $240671.1000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 79 108 596.214287 $32195.6000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 60 76 539.068256 $43837.0500 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 1.142857 $92.9400 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 3 12.428571 $1010.7000 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $1068.7800 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 13.142857 $1068.7800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 90 124 847.790476 $68942.3600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 8 8 54.571428 $4437.7500 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 6.285714 $511.1500 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 12.142857 $987.4600 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 80 100 625.744452 $50885.5600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 7 63.285715 $5146.3900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 11.714286 $952.6100 $81.3200
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Subtotal (Total Children Is Unduplicated) 683 3196 10088.441453 $883347.2700 $87.5600
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Total 4097 11483.643698 $970705.3800 $84.5300
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Number of Children (Unduplicated) With at Least One Authorization 867