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: 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 4015 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 72 81 99.917457 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 72 81 99.917457 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 1 1 1.000000 $50.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 14 17 25.000000 $1875.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 16.533333 $1338.8700 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 9 9 18.000000 $1457.6400 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 5 6 10.011111 $810.7000 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 15.500000 $1255.1900 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 15 15 23.005556 $1378.5000 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 24.022222 $1439.4100 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 83 83 164.000000 $13280.7200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 81 82 160.500000 $12997.2900 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $647.8400 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 22 22 40.500000 $3279.6900 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 57 57 113.000000 $9150.7400 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 21 21 37.000000 $2996.2600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 87 88 179.000000 $10725.6800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 134 134 263.500000 $15788.9200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 29 33 25.100005 $1458.5900 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 1.505556 $87.4900 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 12 8.305556 $482.6400 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 7 7 2.455557 $142.7000 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.183333 $10.6500 $58.1000
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 39 42 41.031748 $2384.3700 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 6.500000 $377.7200 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.505556 $29.3800 $58.1200
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.122222 $7.1000 $58.1000
PSTH -97163 PT EVAL HIGH COMPLEXITY 16 21 10.022223 $582.4000 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 7 8 4.061111 $235.9900 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.161111 $9.3600 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 26 28 21.350001 $1240.6500 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 1.627778 $94.5900 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.427778 $82.9700 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 34 38 17.612015 $1023.4400 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.033334 $60.0500 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.066667 $61.9900 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 8 5.505557 $319.9400 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 11 13 124.071429 $7209.7900 $58.1100
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Subtotal (Total Children Is Unduplicated) 440 807 1381.220759 $94988.7200 $68.7700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 52 58 45.382115 $226910.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 80 92 84.967462 $4248.3800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 21 28 24.783336 $1239.1800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 3.033333 $75.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 428 531 773.576155 $38678.6400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 135 170 233.592054 $11679.5600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 4 11.676190 $291.9100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 125 150 213.107131 $10655.3000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 95 112 165.115070 $8255.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 0.177778 $4.4500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 193 236 350.131734 $17506.5300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 96 114 133.837289 $6691.8100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.711111 $42.7800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 240 285 396.106335 $19805.2400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 156 180 246.509505 $12325.3800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 18.655555 $466.3900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 30 34 91.880947 $2480.7700 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 521 694 4722.376199 $255008.3000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 69 84 556.268754 $30038.5100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 86 631.928572 $51388.4300 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 3 18.714286 $1521.8500 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 2 13.000000 $1057.1600 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 3 6 35.890476 $2918.6100 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 2 13.000000 $1057.1600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 93 117 730.649998 $59416.4700 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 2 2 12.000000 $975.8400 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 2 2 16.357143 $1330.1600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 15 16 128.866666 $10479.4300 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 2.000000 $162.6400 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 68 95 578.053175 $47007.2700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 4 24.357143 $1980.7300 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 5 40.214286 $3270.2300 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 8.750000 $711.5500 $81.3200
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Subtotal (Total Children Is Unduplicated) 695 3127 10326.669798 $829682.6400 $80.3400
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Total 4015 11807.808014 $924671.3600 $78.3100
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Number of Children (Unduplicated) With at Least One Authorization 898