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 3423 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 70 74 5114.825395 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 22 25 7561.788889 $281298.5500 $37.2000
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Subtotal (Total Children Is Unduplicated) 92 99 12676.614284 $281298.5500 $22.1900
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 4 4 4.000000 $200.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 4.087671 $306.5800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $809.8000 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 0.277778 $22.5000 $80.9900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 6.000000 $485.8800 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 13 13 20.274277 $1214.8400 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 1.022222 $61.2500 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 37 37 74.000000 $5992.5200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 26.266667 $2127.0800 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 11 11 22.000000 $1781.5600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 7 7 14.000000 $1133.7200 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 11 11 22.000000 $1781.5600 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 45 45 90.000000 $5392.8000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 12 12 24.000000 $1438.0800 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 32 43 12.077779 $701.8500 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.383333 $22.2700 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 3 2.472222 $143.6600 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 0.583333 $33.9000 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 31 35 29.096043 $1690.7700 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.177778 $10.3300 $58.1200
PSTF -97164 PT RE-EVAL EST PLAN CARE 24 27 9.673057 $562.0900 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 0.522222 $30.3500 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 4 2.511111 $145.9200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 11 8.338888 $484.5700 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 15 18 5.133334 $298.3000 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 2.155556 $125.2600 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 74 87 33.756345 $1961.5600 $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) 242 409 432.809616 $29561.0800 $68.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 13 12.022222 $60111.0000 $4999.9900
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 384 474 346.708691 $17335.2400 $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 340 407 296.260281 $14812.8400 $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 188 235 2202.614280 $118941.3200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 11.142858 $601.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 44 59 532.933332 $43338.1800 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 26.285714 $2137.5500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 37 56 397.857146 $25908.4400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 28 39 300.368255 $24425.9700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 15 19 191.821430 $12491.4100 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 1 1 20.571429 $1339.6100 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 101 127 953.804765 $77563.4500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 18.142858 $1475.3700 $81.3200
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Subtotal (Total Children Is Unduplicated) 701 2915 6837.010214 $448334.3200 $65.5700
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Total 3423 19946.434114 $759193.9500 $38.0600
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Number of Children (Unduplicated) With at Least One Authorization 815