Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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 2384 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 65 71 86.069843 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 65 71 86.069843 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $647.8400 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 8.022222 $649.6400 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.011111 $0.9000 $80.9000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 13.011111 $1053.6400 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 2.500000 $202.4500 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 9 12.488889 $748.3300 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 12 12 17.511111 $1049.2700 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 38 39 76.500000 $6194.9700 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 43 43 84.500000 $6842.8100 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 11 11 20.000000 $1619.6000 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 39 39 76.000000 $6154.4800 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 19 19 37.000000 $2996.2600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 41 41 78.500000 $4703.7200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 59 59 112.500000 $6741.0000 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 10.000000 $809.8000 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.511111 $29.7000 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 12 14 6.299998 $366.0800 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.055556 $3.2300 $58.1600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.327778 $19.0500 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 7.538889 $438.0900 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 1.466667 $85.2300 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.194444 $11.3000 $58.1000
PSTH -97161 PT EVAL LOW COMPLEXITY 12 14 10.905557 $633.7300 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.511111 $29.7000 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 11 18.791944 $1092.0100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.472222 $27.4400 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 1.105555 $64.2400 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 14 15 11.435388 $664.5100 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 18 20 11.248781 $653.6600 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 1.511112 $87.8200 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.311111 $18.0800 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 2.000000 $116.2200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $174.3300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 13.142857 $763.7300 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 225 415 662.374525 $46860.7600 $70.7500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 24 37.662493 $188313.5000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 31 37 26.788889 $1339.4500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 13 13 14.177778 $708.8900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 285 366 505.573416 $25278.6500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 85 107 157.747619 $7887.3800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 90 107 119.334921 $5966.7500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 54 65 100.302385 $5015.1400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 119 145 176.633336 $8831.6600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 58 70 81.730959 $4086.5700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 175 206 260.193648 $13009.6500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 94 111 140.757938 $7037.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 7.000000 $175.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 11 30.595240 $826.0800 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 328 421 3001.472228 $162079.6700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 55 77 465.038095 $25112.0700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 34 39 292.428573 $23780.3000 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $1068.7800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 35 45 333.642858 $27131.8500 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 5 5 36.785714 $2991.4200 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 6.285714 $511.1500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 33 34 243.361909 $19790.2100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 6 61.285715 $4983.7500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 1.000000 $81.3200 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 420 1898 6112.942285 $536007.1200 $87.6800
-------------------------------------------------------------------------------------------------------------------------------------
Total 2384 6861.386653 $582867.8800 $84.9500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 528