Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4596 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 5 5 10.507937 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 10.507937 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 42 51 28.878157 $1400.6000 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $29.3600 $14.6800
EXIT -EXIT EXIT ASSESSMENT 28 28 38.428571 $1921.4300 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 21.000000 $1575.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 22.000000 $1650.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 28 31 61.500000 $3413.2500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 6 6 11.500000 $862.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.000000 $150.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 7 9 7.122222 $366.1500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 5.813242 $298.8600 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.183562 $9.4400 $51.4200
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 10.285714 $528.7900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.500000 $25.7100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 5 4.500000 $231.3500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 2.000000 $102.8200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.202740 $10.4200 $51.4000
SPCH -92521 EVAL OF SPEECH FLUENCY 9 12 7.259437 $373.2100 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.493150 $25.3600 $51.4200
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.309589 $15.9100 $51.4000
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Subtotal (Total Children Is Unduplicated) 132 203 269.976384 $16035.5600 $59.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 13 30.420634 $152103.0000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.180822 $9.0400 $49.9900
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 52 55 74.908433 $3745.4200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 7.005556 $350.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 2.011111 $50.2800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 415 560 1162.193220 $58109.6700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 3.300000 $165.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 216 268 542.413247 $27120.6900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 3.000000 $150.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 7.066667 $176.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 50 94.495237 $4724.7600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 390 492 972.893220 $48644.6900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 3.066667 $153.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 7.400001 $185.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 18 19 169.971428 $8498.5600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 91 109 1019.038101 $50951.8500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 10 61.000001 $3050.0000 $50.0000
INTR -T1013 INTERPRETER 34 58 167.500001 $8375.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 501 1248 6536.067411 $65360.6100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 12 151.428572 $10896.7900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 19.142857 $1377.5200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 8 10 115.142857 $8285.6800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 15 112.571430 $8100.6300 $71.9600
TRAV -TRAVS Travel by mile 545 1445 350011.082998 $155754.9300 $0.4500
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Subtotal (Total Children Is Unduplicated) 581 4388 361274.300471 $616408.7400 $1.7100
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Total 4596 361554.784792 $632444.2900 $1.7500
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Number of Children (Unduplicated) With at Least One Authorization 599