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 3282 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 85 3240.026985 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 21 26 6637.433334 $246912.5200 $37.2000
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Subtotal (Total Children Is Unduplicated) 102 111 9877.460319 $246912.5200 $25.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 10 18.175342 $1471.8400 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $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 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 10 18.060274 $1082.1700 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 54 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 15 15 30.000000 $2429.4000 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 7 7 14.000000 $1133.7200 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 21 21 42.000000 $3401.1600 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 4 4 8.000000 $647.8400 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 55 55 110.000000 $6591.2000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 19 19 38.000000 $2276.9600 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 39 50 37.065876 $2153.9100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 6.165079 $358.2500 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 1.983333 $115.2500 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 22 23 18.950000 $1101.1800 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 25 32 11.755557 $683.1200 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 4 5 0.757459 $44.0200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 4 3.150000 $183.0500 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 7 3.438889 $199.8300 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 15 16 34.288889 $1992.5300 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.061111 $3.5500 $58.1000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 57 67 25.598413 $1487.5300 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 5.825397 $338.5100 $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) 259 434 575.275619 $39576.6300 $68.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
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 390 460 317.423029 $15871.2200 $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 331 384 273.586515 $13679.3600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 0.877778 $43.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 261 308 428.128578 $10703.2300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 168 195 1631.885726 $88121.7200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 11 108.000001 $5832.0000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 37 47 341.571431 $27776.5200 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 15.714286 $1277.8900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 35 43 348.642860 $22703.6000 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 25 33 227.057939 $18464.3200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 13 20 153.857145 $10019.1900 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 76 98 672.776193 $54710.1000 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 10 60.571430 $4925.6600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 12.857143 $1045.5400 $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) 683 2737 5719.946878 $327286.7200 $57.2200
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Total 3282 16172.682816 $613775.8800 $37.9500
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Number of Children (Unduplicated) With at Least One Authorization 821