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 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 81 87 5611.724600 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 17 19 7324.055555 $272454.8600 $37.2000
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Subtotal (Total Children Is Unduplicated) 98 106 12935.780155 $272454.8600 $21.0600
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 1 1 1.000000 $50.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 4.082192 $306.1700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 11 22.000000 $1781.5600 $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 4 4 8.000000 $647.8400 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 14 22.941400 $1374.6500 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 0.377778 $22.6400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 53 55 108.000000 $8745.8400 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 12 12 24.000000 $1943.5200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $971.7600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 8 8 16.000000 $1295.6800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 22 22 44.000000 $3563.1200 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 55 55 109.000000 $6531.2800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $599.2000 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 39 42 16.416665 $953.9600 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.511111 $87.8100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.894444 $51.9700 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 22 23 20.777778 $1207.4000 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 22 26 9.446272 $548.9300 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 3 3 1.046880 $60.8400 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.511111 $145.9200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 7 5.772222 $335.4200 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 14 15 3.961112 $230.1900 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 69 72 26.205556 $1522.8100 $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) 246 396 475.944521 $33418.6400 $70.2200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 4.788888 $23944.0000 $4999.9100
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 417 511 346.292033 $17314.4500 $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 365 446 299.915844 $14995.6500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 3 0.833334 $41.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 273 336 455.679371 $11392.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 191 230 1806.842853 $97569.6200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 61.714285 $3332.5700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 42 53 452.428569 $36791.5200 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.285714 $185.8700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 29 36 368.714283 $24010.6900 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 29 32 276.292061 $22468.1300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 15 16 164.607143 $10719.2300 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 88 99 838.209520 $68163.3200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 7 39.571428 $3217.9500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 11.000000 $894.5200 $81.3200
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Subtotal (Total Children Is Unduplicated) 722 2921 6333.317367 $374533.9900 $59.1400
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Total 3423 19745.042043 $680407.4900 $34.4600
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Number of Children (Unduplicated) With at Least One Authorization 850