Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2177 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 8 10 14.890476 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 60.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 11 74.890476 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 53 62 55.953455 $2713.7500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 4 4.000000 $246.8400 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 3 1.500000 $22.7900 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $24.2800 $24.2800
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.000000 $78.2500 $78.2500
EXIT -EXIT COS Exit 13 13 9.010960 $450.5400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 12 12 20.010958 $1620.4900 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 12.000000 $971.7600 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 8 8 16.000000 $1295.6800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 9 9 18.000000 $1457.6400 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 28 29 54.010958 $3236.3400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 22.000000 $1318.2400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 25 50.000000 $4049.0000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 8.500000 $688.3300 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 8 10 4.178615 $242.8200 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 1.204108 $69.9800 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.098630 $5.7300 $58.0900
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 1.683333 $97.8200 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 0.312328 $18.1500 $58.1200
SPCH -92521 EVAL OF SPEECH FLUENCY 8 10 4.777473 $277.6100 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.500000 $29.0600 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 8.174560 $475.0300 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.147945 $8.5900 $58.0900
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.002740 $58.2700 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 140 236 302.066063 $19931.3100 $65.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 11 30.533877 $152670.0000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 66 72 106.450210 $5322.5200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 23 25 24.358334 $1217.9200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 430 571 1133.071437 $56653.6300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 7 21.557142 $1077.8600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.966667 $49.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 261 335 662.809528 $33140.5000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 3.133333 $156.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.066667 $51.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 6 9.500000 $475.0000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 2.300000 $115.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 6 10.133334 $253.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 381 479 924.776198 $46238.8400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 2 3.300000 $165.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 6 23.290476 $582.2600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 109 139 1067.952387 $57669.3500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 8 68.857142 $3718.2800 $54.0000
INTR -T1013 INTERPRETER 29 41 113.571429 $5678.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 36 71 306.109524 $3673.3100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 22 71.142859 $5785.3300 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 6.000000 $487.9200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 8 8 44.571428 $3624.5600 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 9.142857 $595.3900 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 26 169.933661 $13818.9900 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.166667 $94.8800 $81.3200
TRAV -TRAVS Travel by mile 46 87 9481.042860 $4219.0600 $0.4500
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Subtotal (Total Children Is Unduplicated) 522 1930 14298.738017 $397535.0000 $27.8000
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Total 2177 14675.694556 $417466.3100 $28.4500
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Number of Children (Unduplicated) With at Least One Authorization 577