Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 7160 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 120 135 191.930955 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 120 135 191.930955 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 38 50 47.649315 $2311.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $123.4200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.1900 $15.1900
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 2.000000 $15.8400 $7.9200
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $54.9000 $54.9000
EXIT -EXIT COS Exit 75 81 72.538454 $3626.9300 $50.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 4.000000 $323.9200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $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 9 10 20.000000 $1198.4000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 8.000000 $479.3600 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 11 22.000000 $1781.5600 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 138 176 197.187769 $11187.6000 $56.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 11 10.041096 $50205.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 276 304 329.707275 $16485.3600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 52 60 51.282879 $2564.1400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 40 38.407861 $960.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 332 442 1021.241267 $51062.0400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 28 35 54.883330 $2744.1500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 8 10.088889 $252.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 117 151 318.988882 $15949.4100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 18 20 46.438094 $2321.9000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 9 12.683334 $317.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 124 159 365.080954 $18254.0600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 12 13 25.733334 $1286.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 3 5.033333 $125.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 181 233 501.479368 $25073.9700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 15 17 32.595236 $1629.7600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 10.488889 $262.2200 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 2.428571 $121.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 60 70 560.787304 $30282.4900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 14 17 161.571430 $8724.8500 $54.0000
INTR -T1013 INTERPRETER 186 244 559.928574 $27996.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1492 2455 17310.677088 $207727.9100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 5.000000 $406.6000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 10 12 69.428573 $5645.9200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 3 25.714286 $2091.0900 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 12.857143 $1045.5400 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 9 36.685715 $2983.2800 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 16.457143 $1338.2900 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 9.285714 $604.6800 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 34.285714 $2788.1100 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 4.857143 $76.5500 $15.7600
TRAN -TRAN *FAMILY TRANSPORTATION 1 1 4.142857 $414.2900 $100.0000
TRAV -TRAVS Travel by mile 1515 2518 17281.524708 $7690.2700 $0.4400
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Subtotal (Total Children Is Unduplicated) 1614 6849 38929.805984 $489432.2200 $12.5700
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Total 7160 39318.924708 $500619.8200 $12.7300
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Number of Children (Unduplicated) With at Least One Authorization 1698