Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 2833 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 19 23 14.722223 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.022222 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 20 24 15.744445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 22 23 23.000000 $1336.5300 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 15 16.000000 $929.7600 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 20 20 22.666667 $1317.1600 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 5.000000 $290.5500 $58.1100
SCREEN-T1023 SCREENING 43 45 50.593651 $2731.0400 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 14 14 14.666667 $852.2800 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 10.000000 $581.1000 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 5 5.000000 $290.5500 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 38 45 225.126983 $13082.1500 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 4.866667 $282.8000 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 159 185 378.920635 $21810.1500 $57.5600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 4 8.383334 $419.1700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 398 549 1704.300008 $85215.0400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 3.066667 $153.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 273 345 1169.900002 $58495.0100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 140 196 772.855560 $38642.8000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 2.000000 $100.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 223 268 847.622232 $42381.1600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 11 16 52.000000 $1300.0000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 6.066667 $303.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 659 822 4696.126143 $253590.9600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 6.133333 $331.2000 $54.0000
INTR -T1013 INTERPRETER 5 5 40.761904 $2038.1000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 100 121 577.528567 $46964.6800 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 3.066667 $249.3800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 17 18 121.761903 $7929.1500 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 8.000000 $520.9600 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 3.000000 $195.3600 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 84 105 412.366668 $33533.7100 $81.3200
PHY -97110HM PT SESSION BY PT ASST 23 28 230.373805 $15001.9400 $65.1200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 2.000000 $459.2200 $229.6100
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 111 135 606.231736 $49298.7400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 2 5.485714 $446.1000 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 834 2624 11280.030910 $637619.3400 $56.5300
-------------------------------------------------------------------------------------------------------------------------------------
Total 2833 11674.695990 $659429.4800 $56.4800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 878