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 2361 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 77 85 89.857138 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 77 85 89.857138 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 4.500000 $337.5000 $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 4 4 7.500000 $607.3500 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 8.000000 $647.8400 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 2.011111 $162.8600 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $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 11 11 12.044444 $721.7000 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 8.000000 $479.3600 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 29 29 58.000000 $4696.8400 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 12 12 23.000000 $1862.5400 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 11 11 20.500000 $1660.0900 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 12 12 23.000000 $1862.5400 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 5 5 10.000000 $809.8000 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 32 33 63.500000 $3804.9200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 33 33 64.000000 $3834.8800 $59.9200
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 0.616666 $35.8300 $58.1000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.166667 $9.6900 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.600000 $34.8700 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 1.000000 $58.1100 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.172222 $10.0100 $58.1000
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.000000 $58.1100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.550000 $31.9600 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.122222 $7.1000 $58.1000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.344444 $20.0100 $58.1000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.166667 $9.6900 $58.1200
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 12.857143 $747.1300 $58.1100
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Subtotal (Total Children Is Unduplicated) 104 191 335.151586 $23509.8600 $70.1500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 10 7.605479 $38027.5000 $5000.0100
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 388 511 716.819044 $35840.9600 $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 242 309 313.150797 $15657.5600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 146 179 216.518253 $10825.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 4.277777 $106.9400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 9 23.395238 $631.6700 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 135 174 1125.365084 $60769.6300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 18 20 123.712701 $6680.4800 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 12 91.800001 $7465.1800 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 9.714286 $789.9700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 2 12.857143 $1045.5500 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 12.857143 $1045.5400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 11 11 66.980951 $5446.9000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 7.714286 $627.3300 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 25.500000 $2073.6600 $81.3200
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Subtotal (Total Children Is Unduplicated) 531 2085 3872.979301 $242453.8900 $62.6000
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Total 2361 4297.988025 $265963.7400 $61.8800
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Number of Children (Unduplicated) With at Least One Authorization 629