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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 10944 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 7 32.752381 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 7 32.752381 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 89 135 93.820703 $4550.3100 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 5 4.166667 $61.1700 $14.6800
EXIT -EXIT EXIT ASSESSMENT 104 106 123.568311 $6178.4100 $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 4 4 8.000000 $444.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 50 50 86.532874 $6489.9800 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 36 37 72.000000 $5400.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 16 16 32.000000 $2400.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 10 10 20.000000 $1500.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 115 122 225.038353 $12489.6400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 26 26 50.500000 $2802.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 30 31 59.500000 $4462.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 16 16 30.500000 $2287.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 2 9.700000 $485.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 2.330518 $119.8100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 11 16 13.411110 $689.4600 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 3.846576 $197.7500 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.265753 $13.6600 $51.4200
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 23.285714 $1197.1200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 2 1.094445 $56.2700 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 3.027778 $155.6600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 2.515297 $129.3100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 3.000000 $154.2300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.144444 $7.4200 $51.3900
SPCH -92521 EVAL OF SPEECH FLUENCY 12 15 9.188813 $472.4000 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.323288 $16.6200 $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 6 6 2.468950 $126.9300 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.356164 $18.3100 $51.4200
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.522222 $26.8500 $51.4100
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Subtotal (Total Children Is Unduplicated) 367 623 886.107980 $53245.4600 $60.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 20 26 100.929277 $504646.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 4.398630 $219.9300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 2.000000 $138.7000 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 152 178 289.325537 $14466.2900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 15 18 17.113097 $855.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 13.116667 $327.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 726 1277 4990.114648 $249505.7600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 6 11.433333 $571.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 379 599 2278.461533 $113923.0800 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 7 8 20.800001 $1040.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 7 29.433333 $735.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 79 121 492.040478 $24602.0400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.500000 $62.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 682 1089 4089.746398 $204487.3600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 8 10 29.533335 $1476.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 13 45.766668 $1144.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 26 32 463.480953 $23174.0500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 165 259 4163.212693 $208160.6700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 16 20 213.642857 $10682.1400 $50.0000
INTR -T1013 INTERPRETER 62 132 514.354661 $25717.7300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 890 2873 26859.393377 $322312.7700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 17 22 341.857142 $24600.0500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 27.714286 $1994.3200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 11 15 287.285713 $20673.0900 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 19 24 310.571430 $22348.7200 $71.9600
TRAV -TRAVS Travel by mile 1061 3573 1457971.793278 $648797.4500 $0.4500
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Subtotal (Total Children Is Unduplicated) 1116 10314 1503573.019325 $2426783.9000 $1.6100
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Total 10944 1504491.879686 $2480029.3700 $1.6500
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Number of Children (Unduplicated) With at Least One Authorization 1164