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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4952 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 3 3 9.977778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 9.977778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 55 68 39.422528 $1912.0100 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 3 2.166667 $31.8100 $14.6800
EXIT -EXIT EXIT ASSESSMENT 30 31 37.712264 $1885.6200 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
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 12 12 18.016437 $1351.2400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 19 21 35.016437 $1943.4200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 6 10.000000 $750.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 9.000000 $675.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.566667 $28.3400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 7.238889 $372.1500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 1.397261 $71.8400 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.082192 $4.2300 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 13.000000 $668.3300 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 2 0.505556 $25.9900 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.8200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.033333 $53.1200 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 3.000000 $154.2300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 8 9 4.571538 $235.0300 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.164384 $8.4500 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.249315 $12.8200 $51.4100
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Subtotal (Total Children Is Unduplicated) 130 197 219.143468 $12719.4200 $58.0400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 17 36.758219 $183791.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 2.000000 $138.7000 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 62 68 99.452861 $4972.6500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 5 6 4.019445 $200.9800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 0.772222 $19.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 446 592 1245.764237 $62287.9700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 3 2.066667 $103.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 252 312 623.998493 $31199.7900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 7.499999 $375.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 9.100000 $227.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 50 107.599996 $5379.9800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.500000 $62.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 430 533 1071.810271 $53590.2900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.433333 $121.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 9.933333 $248.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 21 22 206.738095 $10336.9100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 97 122 972.690481 $48634.5000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 12 86.928571 $4346.4300 $50.0000
INTR -T1013 INTERPRETER 15 25 59.843703 $2992.1900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 519 1337 6832.837175 $81993.9900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 12 71.571428 $5150.2900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 8.571429 $616.8000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 8 10 37.000000 $2662.5200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 13 86.857144 $6250.2400 $71.9600
TRAV -TRAVS Travel by mile 575 1597 393627.371110 $175164.1800 $0.4500
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Subtotal (Total Children Is Unduplicated) 597 4752 405218.118212 $680917.0100 $1.6800
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Total 4952 405447.239458 $693636.4300 $1.7100
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Number of Children (Unduplicated) With at Least One Authorization 608