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: 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 5677 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 74 78 5453.536506 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 104 112 38054.900794 $1415642.3100 $37.2000
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Subtotal (Total Children Is Unduplicated) 178 190 43508.437300 $1415642.3100 $32.5400
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.022222 $15.5300 $15.1900
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.283333 $10.1600 $7.9200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.261111 $3.9700 $15.1900
EXIT -EXIT COS Exit 4 4 4.000000 $200.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 12 16 24.754337 $1856.5700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 53 55 88.726481 $7185.0600 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 7 7 8.915068 $721.9400 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 8.011111 $648.7400 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 28.000000 $2267.4400 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 31 31 49.940563 $2992.4400 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 3.203043 $191.9200 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 270 273 543.066667 $43977.5400 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 49 52 102.266667 $8281.5600 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 61 61 122.000000 $9879.5600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 12 12 24.000000 $1943.5200 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 63 63 124.066667 $10046.9200 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 15 15 30.000000 $2429.4000 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 144 144 288.000000 $17256.9600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 27 27 54.000000 $3235.6800 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 107 136 59.615077 $3464.2200 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.383333 $22.2700 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 3 4 2.557154 $148.5900 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 12 3.927777 $228.2400 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 100 109 105.605563 $6136.7200 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 6 6 3.788889 $220.1700 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 63 77 41.329873 $2401.6600 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 4 4 1.211111 $70.3800 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.138889 $8.0700 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 15 11.044444 $641.7900 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 3 2.466667 $143.3400 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 32 35 29.429755 $1710.1500 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 1.122222 $65.2100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 3 1.274277 $19.2500 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 36 42 12.655558 $735.4300 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 2.338889 $135.9100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 216 267 106.951095 $6214.9100 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 6.216666 $361.2500 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 -0.066666 $-3.8700 $58.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 1.388889 $80.7100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 802 1528 1912.896732 $136945.8300 $71.5900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 15 12.922222 $64611.0000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 5 6 2.533332 $586.7400 $231.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 31 15.809527 $790.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 2 2 1.500000 $75.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 14 16 8.922222 $223.0600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 387 477 349.297580 $17464.6800 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 6 3.066666 $153.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 234 289 389.294440 $9732.3500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 198 410 265.903156 $13295.0700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 5 2.488888 $124.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 85 206 244.902377 $6122.5500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 66 157 96.438878 $4821.8900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 0.411111 $20.5600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 28 68 113.984133 $2849.6200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 341 408 296.938059 $14846.7300 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 3 2.000000 $100.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 227 281 381.755555 $9543.8900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 438 548 4983.104760 $269088.0000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 19 22 163.714285 $8840.5900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 136 182 1452.642856 $118129.0100 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 26.285714 $2137.5500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 140 198 1793.571430 $116797.4000 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 13.142857 $855.8700 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 5.285714 $344.2000 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 75 100 811.477779 $65989.4200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 75 100 821.464287 $53493.7800 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 2 2 33.714286 $2195.4800 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 4 4 0.843836 $193.7700 $229.6300
SENS -V5264 EARMOLD 6 7 4.766666 $86.4200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 292 375 2776.456377 $225781.5300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 11 45.857145 $3729.0900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 20 24 166.333336 $13526.2200 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.533333 $206.0100 $81.3200
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Subtotal (Total Children Is Unduplicated) 948 3959 15289.362807 $1026755.7200 $67.1500
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Total 5677 60710.696839 $2579343.8600 $42.4900
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Number of Children (Unduplicated) With at Least One Authorization 1186