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: 07-01-24 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 3047 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 4 4 3.166666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 3.166666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 46 58 43.317035 $2100.8700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 5 3.252054 $200.6800 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.061111 $0.9300 $15.1900
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.123288 $5.5900 $45.3200
EXIT -EXIT COS Exit 9 9 9.000000 $450.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 3 4.005479 $324.3700 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3300 $60.1600
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 58 58 103.032874 $8343.6100 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 20.000000 $1619.6000 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 21 21 40.500000 $3279.6900 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 16 17 34.000000 $2753.3200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 62 62 109.032874 $6533.2600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 28.000000 $1677.7600 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 40 56 109.500000 $8867.3100 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 7 15 30.000000 $2429.4000 $80.9800
OCTF -97168GT OT RE-EVAL EST PLAN CARE 3 3 0.235617 $13.6900 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 49 53 39.447891 $2292.3300 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 1.755556 $102.0200 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 16 20 8.377245 $486.8000 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 1.506849 $87.5700 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.319026 $18.5400 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.087671 $5.1000 $58.1300
PSTH -97161 PT EVAL LOW COMPLEXITY 32 39 33.002218 $1917.7700 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 3 2.488889 $144.6300 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 12 13 7.167733 $416.5200 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.252055 $14.6500 $58.1200
SPCH -92521 EVAL OF SPEECH FLUENCY 65 75 53.662035 $3118.3200 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 2 2.000000 $116.2200 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 9 15 4.527549 $263.0900 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 4 0.692999 $40.2700 $58.1100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.093151 $5.4200 $58.1400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 15 16 14.238889 $827.4200 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 1.244444 $72.3100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 4 0.918722 $53.3900 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 4.000000 $232.4400 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 11.142857 $647.5100 $58.1100
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Subtotal (Total Children Is Unduplicated) 260 601 734.991590 $50494.5200 $68.7000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 47 60 131.136617 $655683.5000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 58 60 72.647753 $3632.3900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 12 12 16.316667 $815.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 328 445 925.771452 $46288.6900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 7 8 15.566667 $778.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.100000 $27.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 191 231 479.933022 $23996.7300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 1.800000 $90.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.133333 $153.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 7.766667 $388.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 4 9.200001 $230.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 297 370 799.661924 $39983.1900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.233333 $111.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 9 16.376190 $409.4100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 301 385 3144.742859 $169816.3300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 49 52 498.000000 $26892.0400 $54.0000
INTR -T1013 INTERPRETER 22 33 93.129058 $4656.4700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 91 210 897.238096 $10766.8700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 91 109 917.466668 $74608.4300 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 0.266667 $21.6900 $81.3300
PHY -97110 PT SESSION BY LICENSED PT 52 61 602.126982 $48965.0400 $81.3200
PHY -97110HM PT SESSION BY PT ASST 5 7 62.142857 $4046.7500 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 115 138 1118.298411 $90940.1400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 4 20.142857 $1638.0200 $81.3200
TRAV -TRAVS Travel by mile 91 232 46085.788205 $20508.1800 $0.4500
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Subtotal (Total Children Is Unduplicated) 425 2442 55925.986286 $1225680.4600 $21.9200
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Total 3047 56664.144542 $1276174.9800 $22.5200
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Number of Children (Unduplicated) With at Least One Authorization 461