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 1388 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 64 70 85.847621 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 64 70 85.847621 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 1.000000 $59.9200 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 3.500000 $283.4300 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.500000 $89.8800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $359.5200 $59.9200
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.472222 $27.4400 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.472222 $27.4400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.171004 $9.9400 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 10 16 20.115448 $1355.8200 $67.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.252055 $11260.5000 $5000.1000
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 32 42 241.476189 $13039.7400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 14 91.642857 $4948.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 13.071429 $1062.9700 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $1068.7800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 4 5 36.357143 $2956.5600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.500000 $203.3000 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 5.357143 $435.6500 $81.3200
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Subtotal (Total Children Is Unduplicated) 344 1302 1996.040562 $114313.2300 $57.2700
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Total 1388 2102.003631 $115669.0400 $55.0300
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Number of Children (Unduplicated) With at Least One Authorization 396