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: 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 5445 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 88 3241.582540 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 116 133 42735.505556 $1589760.8100 $37.2000
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Subtotal (Total Children Is Unduplicated) 199 221 45977.088096 $1589760.8100 $34.5800
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 9 16.000000 $1200.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 45 46 77.486453 $6274.8500 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 7 7 12.511111 $1013.1500 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 7.000000 $566.8600 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 18.000000 $1457.6400 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 23 24 38.465754 $2304.8700 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 6.093151 $365.1000 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 312 315 623.285714 $50473.6800 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 60 61 122.000000 $9879.5600 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 83 83 164.285714 $13303.8600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 16 16 31.000000 $2510.3800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 75 75 150.000000 $12147.0000 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 13 13 26.000000 $2105.4800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 142 143 285.000000 $17077.2000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 43 44 88.000000 $5272.9600 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 115 138 87.939155 $5110.1700 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 8.165079 $474.4700 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.079452 $4.6200 $58.1400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 18 18 8.394443 $487.7900 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 82 87 71.981507 $4182.8400 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 4.000000 $232.4400 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 62 76 27.902511 $1621.4200 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 6 7 0.959133 $55.7400 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 10 11 8.405555 $488.4400 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 22 23 13.735387 $798.1500 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.277778 $16.1400 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.219178 $18.4200 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 32 33 40.511111 $2354.1000 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 0.888889 $51.6500 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 187 213 94.524188 $5492.8000 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 4 15.682540 $911.3100 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 5.055556 $293.7800 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $116.2200 $58.1100
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Subtotal (Total Children Is Unduplicated) 812 1496 2065.849359 $149277.5800 $72.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 7.000000 $35000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.888889 $437.5100 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 34 37 25.111112 $1255.5600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 1 0.500000 $25.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 12 12 11.066666 $276.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 391 461 317.778585 $15889.0000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 3 2.066667 $103.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 275 326 437.178576 $10929.4800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 191 364 246.911106 $12345.5300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 94 197 252.973807 $6324.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 128 78.077780 $3903.9000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 1.077778 $53.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 20 51 66.033332 $1650.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 332 385 273.942071 $13697.1400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 0.877778 $43.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 261 309 431.028578 $10775.7300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 455 543 4495.028611 $242731.1800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 28 30 211.571431 $11424.8700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 115 148 1051.340486 $85494.9000 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 23.571429 $1916.8300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 134 165 1631.964296 $106273.4800 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 1.357143 $88.3700 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 69 92 666.853181 $54228.4300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 68 98 852.071431 $55486.8900 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 2 3 25.714286 $1674.5200 $65.1200
SENS -V5264 EARMOLD 2 2 1.888889 $34.2500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 258 322 2415.666681 $196441.8400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 11 13 109.000002 $8863.8600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 21 22 173.633334 $14119.8100 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 3.000000 $243.9600 $81.3200
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Subtotal (Total Children Is Unduplicated) 942 3728 13816.173925 $891734.9700 $64.5400
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Total 5445 61859.111380 $2630773.3500 $42.5300
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Number of Children (Unduplicated) With at Least One Authorization 1241