Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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: 04-01-25 and 06-30-25 Date of Report: 07-19-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4327 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 112 118 73.179358 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 112 118 73.179358 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $61.7100 $61.7100
OCTH -97165TL OT EVAL LOW COMPLEXITY 2 2 0.605556 $35.1900 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 2 0.505556 $29.3800 $58.1200
OCTH -97167TL OT EVAL HIGH COMPLEXITY 105 123 44.577798 $2590.5300 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 0.916667 $53.2700 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.416667 $24.2100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 91 106 37.055573 $2153.4000 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 85 100 33.244456 $1931.9000 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.100000 $5.8100 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 4 4 1.577779 $91.6900 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 8 3.033334 $176.2700 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 6 8 92.000000 $5346.1200 $58.1100
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Subtotal (Total Children Is Unduplicated) 199 358 215.033386 $12499.4900 $58.1300
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 7 8 6.505556 $1506.8300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 46 155 40.872244 $2043.7200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 1 0.422222 $21.1100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 2.411111 $120.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 2.966666 $148.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 11.166667 $558.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 2.644444 $132.2200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 2 1.011111 $50.5600 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 151 240 1457.999989 $39366.0300 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1166 1415 12490.480971 $674486.0000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 6 7 45.285714 $2445.4300 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1171 1440 12692.569863 $152310.8500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 13.000000 $1057.1600 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 157 204 1470.192856 $119556.0900 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 1 1 0.857143 $69.7000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 5 7 59.000000 $4797.8800 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 113 150 1091.978571 $88799.7200 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 3 19.500000 $1585.7500 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 13.000000 $846.5600 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 145 199 1177.196031 $95729.6000 $81.3200
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Subtotal (Total Children Is Unduplicated) 1393 3851 30599.061159 $1185632.4200 $38.7500
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Total 4327 30887.273903 $1198131.9100 $38.7900
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Number of Children (Unduplicated) With at Least One Authorization 1484