Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 3721 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 43 44 4151.636509 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 85 91 31723.923016 $1180129.9400 $37.2000
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Subtotal (Total Children Is Unduplicated) 128 135 35875.559525 $1180129.9400 $32.9000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 2 2 2.000000 $100.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 9 11 16.666666 $1250.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 40 42 64.726481 $5241.5400 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 5 5 8.115068 $657.1600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 6.011111 $486.7800 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 22.000000 $1781.5600 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 20 20 32.341781 $1937.9200 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 2.180821 $130.6700 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 185 187 372.066667 $30129.9600 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 19 20 40.000000 $3239.2000 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 41 41 82.000000 $6640.3600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $809.8000 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 38 38 74.066667 $5997.9200 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 11 11 22.000000 $1781.5600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 103 103 206.000000 $12343.5200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 15 15 30.000000 $1797.6000 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 68 86 43.826189 $2546.7300 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.084932 $63.0400 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 8 2.299999 $133.6500 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 66 71 75.805564 $4405.0500 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 5 5 3.611111 $209.8400 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 42 48 20.374275 $1183.9400 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 3 3 0.800000 $46.4900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.138889 $8.0700 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 8 5.533333 $321.5400 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 3 2.466667 $143.3400 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 21 22 19.055555 $1107.3100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 21 25 8.116668 $471.6700 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.183333 $10.6500 $58.1000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 135 167 68.385951 $3973.9000 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 5.022222 $291.8400 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.705556 $41.0000 $58.1100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 1.388889 $80.7100 $58.1100
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Subtotal (Total Children Is Unduplicated) 532 985 1261.974395 $90302.7200 $71.5600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 4.511111 $22555.5000 $4999.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 17 11.238890 $561.9500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 2 2 1.500000 $75.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 11 5.400000 $135.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 262 323 235.742835 $11787.0300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.122222 $6.1100 $49.9900
CONIP -CONIP CONSULT, ITDS PHONE 157 191 260.611108 $6515.2700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 135 283 196.808717 $9840.3700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.122222 $6.1100 $49.9900
CONOP -CONOP CONSULT, OT, PHONE 64 157 193.877775 $4846.9400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 95 62.061106 $3103.0300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 0.411111 $20.5600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 20 48 84.150797 $2103.7800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 225 271 195.293630 $9764.5800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 2 1.222222 $61.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 153 190 256.144445 $6403.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 282 354 3198.776190 $172734.1300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 20 158.857142 $8578.3000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 84 109 811.785714 $66014.4900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 97 136 1303.428570 $84879.3000 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 13.142857 $855.8700 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 5.285714 $344.2000 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 48 61 494.349206 $40200.5200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 51 63 555.357144 $36164.8700 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 2 2 33.714286 $2195.4800 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 178 225 1654.723033 $134562.1700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 5 26.785715 $2178.2100 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 20 24 166.333336 $13526.2200 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.533333 $206.0100 $81.3200
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Subtotal (Total Children Is Unduplicated) 626 2601 9934.290431 $640225.7000 $64.4500
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Total 3721 47071.824351 $1910658.3600 $40.5900
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Number of Children (Unduplicated) With at Least One Authorization 793