Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 7820 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 134 149 148.153178 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 134 149 148.153178 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 39 50 52.424789 $2542.6200 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 5 3.250000 $49.3700 $15.1900
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.000000 $7.9200 $7.9200
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 3.066667 $168.3600 $54.9000
EXIT -EXIT COS Exit 110 111 80.587869 $4029.3900 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 27.000000 $1617.8400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $599.2000 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 10 19.000000 $1538.6200 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $485.8800 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 178 213 225.329325 $12833.1200 $56.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 9 8.063014 $40315.0000 $4999.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 293 332 373.526076 $18676.3100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 47 52 43.255711 $2162.7700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 33 33 42.386074 $1059.6500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 403 491 1125.145258 $56257.3600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 29 37 59.714288 $2985.7300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 10.683333 $267.0800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 145 173 357.239687 $17862.0100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 14 15 45.909525 $2295.4900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 6.133334 $153.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 159 191 409.177785 $20458.9300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 15 15 31.966668 $1598.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 6.866666 $171.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 233 282 576.603983 $28830.2700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 21 25 34.943653 $1747.1900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 15.683332 $392.0800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 64 78 644.742857 $34816.1400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 31 39 327.895235 $17706.3700 $54.0000
INTR -T1013 INTERPRETER 205 283 734.745237 $36737.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1682 2652 20019.866626 $240238.6600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 6 44.133333 $3588.9300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 14 14 113.847618 $9258.0900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 4 30.714286 $2497.6900 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 0.571429 $46.4700 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 11 101.838094 $8281.4800 $81.3200
TRAN -TRAN *FAMILY TRANSPORTATION 1 1 2.000000 $200.0000 $100.0000
TRAV -TRAVS Travel by mile 1699 2693 20021.509483 $8909.5900 $0.4500
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Subtotal (Total Children Is Unduplicated) 1784 7458 45189.162585 $557513.9000 $12.3400
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Total 7820 45562.645088 $570347.0200 $12.5200
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Number of Children (Unduplicated) With at Least One Authorization 1873