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: 10-01-25 and 12-31-25 Date of Report: 01-07-26 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2806 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 57 62 48.219050 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.688889 $31.4700 $45.6800
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Subtotal (Total Children Is Unduplicated) 58 63 48.907939 $31.4700 $0.6400
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 7 8 7.500000 $375.0000 $50.0000
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 4 4 6.011111 $486.7800 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 2.011111 $162.8600 $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 3.000000 $242.9400 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 1.000000 $80.9800 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 9 13.000000 $778.9600 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 7 7 11.011111 $659.7900 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 35 35 68.500000 $5547.1300 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 16 17 34.000000 $2753.3200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $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 18 18 34.000000 $2753.3200 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 6 6 11.500000 $931.2700 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 21 22 45.785714 $2743.4800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 48 48 95.500000 $5722.3600 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $323.9200 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 2.511111 $145.9200 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.005556 $0.3300 $58.5700
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.444444 $25.8200 $58.1000
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.511111 $29.7000 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 5.788889 $336.3900 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 2.033333 $118.1600 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.372222 $21.6300 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 3 3 1.161111 $67.4700 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 1.850685 $107.5400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.577778 $149.8000 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 1.788889 $103.9500 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 13.142857 $763.7300 $58.1100
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Subtotal (Total Children Is Unduplicated) 125 225 391.007033 $27202.1500 $69.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 29 24.188432 $120942.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 82 93 107.276187 $5363.7900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 34 48 39.022221 $1951.1100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 3.166667 $79.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 476 588 958.746044 $47937.3400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 160 201 329.597625 $16479.8800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 134 163 234.106349 $11705.3200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 124 147 203.373019 $10168.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 196 242 339.584923 $16979.2400 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 106 134 221.018263 $11050.9400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 6 6 5.333334 $133.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 267 309 441.810315 $22090.4800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 177 207 319.877787 $15993.9300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 14 16 25.022224 $625.5600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 15 17 62.080954 $1676.1900 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 177 230 1569.852376 $84772.1100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 26 35 206.885713 $11171.8400 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3 3 10.142857 $121.7100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 16 100.066667 $8137.4500 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 13.142857 $1068.7800 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 3.714286 $302.0500 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.142857 $174.2600 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.714286 $58.0900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 9 11 42.357142 $3444.5000 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 2 4.857143 $394.9800 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 7.571429 $615.7100 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 10 91.571427 $7446.6000 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 18.000000 $1463.7600 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.857143 $394.9800 $81.3200
TRAV -TRAVS Travel by mile 1 1 1.000000 $0.4500 $0.4500
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Subtotal (Total Children Is Unduplicated) 642 2518 5391.080527 $402744.6800 $74.7100
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Total 2806 5830.995499 $429978.3000 $73.7400
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Number of Children (Unduplicated) With at Least One Authorization 729