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: 10-01-24 and 12-31-24 Date of Report: 03-31-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5649 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 84 91 5625.769044 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 106 120 40249.983333 $1497299.3800 $37.2000
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Subtotal (Total Children Is Unduplicated) 190 211 45875.752377 $1497299.3800 $32.6400
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.088889 $1.3500 $15.1900
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.088889 $0.7000 $7.9200
EXIT -EXIT COS Exit 1 1 1.000000 $50.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 13 14 19.337748 $1450.3400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 51 54 87.012785 $7046.3000 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 5 5 8.022222 $649.6400 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.000000 $80.9800 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 20.000000 $1619.6000 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 31 33 49.766516 $2982.0100 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 6.454490 $386.7500 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 301 305 605.000000 $48992.9000 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 42 44 88.000000 $7126.2400 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 38 38 76.000000 $6154.4800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 17 17 34.000000 $2753.3200 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 95 95 190.000000 $15386.2000 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 8 8 16.000000 $1295.6800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 155 155 309.000000 $18515.2800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 16 16 32.000000 $1917.4400 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 118 147 70.778473 $4112.9400 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 2.033333 $118.1600 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 11 11 5.016666 $291.5100 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 4.000000 $232.4400 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 79 84 92.788030 $5391.9100 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 0.611111 $35.5100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 58 68 25.275193 $1468.7600 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 5 5 1.396880 $81.1700 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.172222 $10.0100 $58.1000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 14 16 9.305556 $540.7500 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 1.477778 $85.8800 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 24 26 21.910731 $1273.2400 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.511111 $29.7000 $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 32 36 19.361112 $1125.0800 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 0.616667 $35.8400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 214 246 92.704870 $5387.0700 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 16.220635 $942.5800 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 4.227778 $245.6800 $58.1100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 2 2.000000 $116.2200 $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) 776 1480 1922.453962 $138509.2700 $72.0500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 6.044444 $30222.0000 $4999.9600
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 2.061111 $477.3900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 23 26 20.960319 $1048.0200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 2 2 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 13 13 11.383333 $284.5800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 418 513 347.403144 $17370.0100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 2 2 1.433333 $71.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 281 343 464.701590 $11617.5500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 190 385 251.770615 $12588.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 81 174 253.420638 $6335.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 136 98.388878 $4919.3900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 1.022222 $51.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 24 57 99.061113 $2476.5300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 366 447 300.938066 $15046.7600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 3 0.833334 $41.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 273 337 457.946038 $11448.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 476 598 4873.961902 $263194.2300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 18 18 178.714285 $9650.5800 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 122 158 1273.792857 $103584.9500 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.285714 $185.8700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 135 171 1772.357135 $115415.9800 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 12.714286 $827.9600 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 6.571429 $427.9300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 70 85 751.073011 $61077.3700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 72 95 887.986506 $57825.7500 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 2 3 25.857143 $1683.8200 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.008219 $1.8800 $229.0800
SENS -V5264 EARMOLD 3 4 2.061111 $37.3700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 270 330 2807.333328 $228292.6300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 12 14 86.214286 $7010.9500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 24 27 200.723808 $16322.8800 $81.3200
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Subtotal (Total Children Is Unduplicated) 980 3958 15201.023198 $979639.4200 $64.4500
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Total 5649 62999.229537 $2615448.0700 $41.5200
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Number of Children (Unduplicated) With at Least One Authorization 1220