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 2479 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 69 78 96.384124 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 69 78 96.384124 $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 3 3 3.500000 $262.5000 $75.0000
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 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 8 11.505556 $689.4200 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 23 23 45.000000 $3644.1000 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 19 19 36.500000 $2955.7700 $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 19.500000 $1579.1100 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 15 15 30.000000 $2429.4000 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 11 11 18.500000 $1498.1300 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 35 35 63.000000 $3774.9600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 33 33 64.500000 $3864.8400 $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 1 1 0.505556 $29.3800 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.655556 $38.1000 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 5 5 1.627779 $94.6000 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 3.044445 $176.9200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 0.472222 $27.4400 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 3 4 0.877778 $51.0100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 3 4 1.750000 $101.6900 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.494444 $86.8400 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.066667 $61.9900 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 8.000000 $464.8800 $58.1100
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Subtotal (Total Children Is Unduplicated) 109 196 330.500003 $23296.5800 $70.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 21 24 17.538812 $87694.0000 $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 426 529 769.531711 $38476.4200 $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 239 284 395.095224 $19754.6800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 156 180 246.509505 $12325.3800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 9.122222 $228.0600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 11 25.276188 $682.4500 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 145 188 1300.354763 $70219.1400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 16 20 99.080954 $5350.3700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 20 122.319049 $9946.9700 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 5.714286 $464.6900 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 2 13.000000 $1057.1600 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 2 13.000000 $1057.1600 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 2 13.000000 $1057.1600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 12 15 77.604761 $6310.8200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 13.000000 $1057.1600 $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 7 8 31.733333 $2580.5500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.714286 $139.4100 $81.3200
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Subtotal (Total Children Is Unduplicated) 578 2205 4377.727582 $319255.6100 $72.9300
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Total 2479 4804.611709 $342552.2000 $71.3000
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Number of Children (Unduplicated) With at Least One Authorization 685