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: 10-01-24 and 12-31-24 Date of Report: 03-31-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2033 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 53 56 5005.552379 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 5 6 1050.011111 $39060.4100 $37.2000
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Subtotal (Total Children Is Unduplicated) 58 62 6055.563490 $39060.4100 $6.4500
Screening, Eval, and Assessment, Class # 02
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 2 4 8.000000 $647.8400 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 7 10.859208 $650.6800 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 17 17 34.000000 $2753.3200 $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 -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 16.000000 $1295.6800 $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 6 6 12.000000 $719.0400 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 16 18 6.177777 $358.9900 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.511111 $29.7000 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 6 5.894444 $342.5200 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 10 3.311113 $192.4200 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.511111 $29.7000 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.511111 $29.7000 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.511111 $87.8100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 1.027778 $59.7300 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 30 32 11.738886 $682.1300 $58.1100
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Subtotal (Total Children Is Unduplicated) 76 125 125.053650 $8897.1700 $71.1500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 21 15.938097 $796.9100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 2 2 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 9.983333 $249.5800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 277 343 234.099186 $11704.8600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 193 235 331.484921 $8287.1200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 139 289 185.715067 $9285.7000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 66 146 194.938892 $4873.4800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 34 87 57.055551 $2852.7600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 1.022222 $51.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 17 41 70.138889 $1753.4700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 238 290 203.188078 $10159.3200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 3 0.833334 $41.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 188 228 322.579370 $8064.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 32 38 316.571427 $17094.8700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 13.142857 $709.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 25 179.428570 $14591.1500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 11 15 131.571427 $8567.9400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 11 12 99.796824 $8115.4900 $81.3200
PHY -97110HM PT SESSION BY PT ASST 8 8 76.035714 $4951.4500 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 37 45 359.142856 $29205.5300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.000000 $81.3200 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 11.000000 $894.5200 $81.3200
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Subtotal (Total Children Is Unduplicated) 450 1846 2819.666615 $157432.4600 $55.8300
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Total 2033 9000.283755 $205390.0400 $22.8200
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Number of Children (Unduplicated) With at Least One Authorization 507