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 1931 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 8 9 1968.300000 $73220.7600 $37.2000
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Subtotal (Total Children Is Unduplicated) 51 53 6119.936509 $73220.7600 $11.9600
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 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 5.186606 $310.7800 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 9 18.000000 $1457.6400 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $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 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $599.2000 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 12 15 4.744445 $275.7000 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.372222 $21.6300 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 12 9.962710 $578.9300 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 10 11 4.066665 $236.3000 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.111111 $6.4600 $58.1000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 2 0.511111 $29.7000 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 4.022222 $233.7300 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 3 4 1.211111 $70.3800 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 31 35 14.673014 $852.6400 $58.1100
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Subtotal (Total Children Is Unduplicated) 69 117 94.861217 $6334.9900 $66.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.000000 $20000.0000 $5000.0000
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 260 321 234.176168 $11708.7000 $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 224 270 194.615852 $9730.6900 $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 37 47 481.714281 $26012.6000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 6.285715 $339.4300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 20 165.999999 $13499.1400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 12 19 115.000000 $7488.8000 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 9 13 88.225396 $7174.5100 $81.3200
PHY -97110HM PT SESSION BY PT ASST 9 12 125.714287 $8186.5200 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 1 1 20.571429 $1339.6100 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 44 52 427.857140 $34793.4000 $81.3200
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Subtotal (Total Children Is Unduplicated) 433 1761 2937.830882 $173952.2200 $59.2100
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Total 1931 9152.628608 $253507.9700 $27.7000
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Number of Children (Unduplicated) With at Least One Authorization 479