Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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 3833 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 79 87 90.834916 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 79 87 90.834916 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 10 10 12.500000 $937.5000 $75.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 1.000000 $55.5000 $55.5000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 21.005479 $1701.0300 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 5 5 10.000000 $809.8000 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 3 3 4.011111 $324.8200 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 13.500000 $1093.2300 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 1.500000 $121.4700 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 20 27.044444 $1620.5000 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 24.005479 $1438.4100 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 87 88 175.500000 $14211.9900 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 81 82 153.500000 $12430.4300 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 7.500000 $607.3500 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 29 29 56.500000 $4575.3700 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 41 42 82.000000 $6640.3600 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 20 20 40.000000 $3239.2000 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 95 96 193.857143 $11615.9200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 135 135 263.000000 $15758.9600 $59.9200
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $485.8800 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 29 33 15.687300 $911.5800 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 0.872222 $50.6800 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 1.311111 $76.1900 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 16 17 9.050001 $525.9000 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 6 6 2.594444 $150.7600 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.172222 $10.0100 $58.1000
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.305556 $17.7600 $58.1200
PSTH -97161 PT EVAL LOW COMPLEXITY 32 34 36.140475 $2100.1100 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.428571 $83.0200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 14 7.844446 $455.8500 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 3 3 1.550000 $90.0700 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 0.622222 $36.1600 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 24 25 17.766667 $1032.4200 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 1.238889 $71.9900 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.505556 $29.3800 $58.1200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 35 37 28.259273 $1642.1400 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.077778 $4.5200 $58.1300
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 9 10 7.861111 $456.8100 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.166667 $67.8000 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 10 11 91.004763 $5288.2700 $58.1100
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Subtotal (Total Children Is Unduplicated) 426 784 1322.882930 $91059.6800 $68.8300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 46 50 45.820850 $229105.0000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 51 61 57.361902 $2868.0900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 21 28 19.838890 $991.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 2.933333 $73.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 390 513 718.685711 $35934.3000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 136 165 211.726985 $10586.3600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 8.071429 $201.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 125 156 210.366670 $10518.3500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 93 105 152.509524 $7625.4800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 186 234 336.080954 $16804.0800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 73 83 114.165875 $5708.3000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.655556 $41.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 243 310 314.150797 $15707.5600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 146 179 216.518253 $10825.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 5.501587 $137.5400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 26 28 68.147616 $1839.9900 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 467 620 4054.619078 $218949.2100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 71 86 506.938374 $27374.6500 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 76 573.858733 $46666.1400 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 12.857143 $1045.5400 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 9.714286 $789.9700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 3 5 38.838096 $3158.3100 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 21.571429 $1754.1900 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 7.714286 $627.3300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 90 117 808.385707 $65737.9000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 13 15 114.471430 $9308.8000 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 20.071429 $1632.2100 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 79 105 670.071429 $54490.1700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 14.000000 $1138.4800 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 24.285714 $1974.9100 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 2 3.285714 $267.1900 $81.3200
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Subtotal (Total Children Is Unduplicated) 640 2962 9364.218780 $783884.4000 $83.7100
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Total 3833 10777.936626 $874944.0800 $81.1800
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Number of Children (Unduplicated) With at Least One Authorization 841