Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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 2754 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 6 7 4.400000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 7 4.400000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 54 65 57.342572 $2781.1200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 5 4.169863 $257.3200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 2 0.500000 $7.6000 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 3.000000 $72.8400 $24.2800
EXIT -EXIT COS Exit 8 8 5.008220 $250.4100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 10.000000 $809.8000 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $599.2000 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 69 70 101.598622 $8227.4900 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 19 19 37.000000 $2996.2600 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 32 35 67.000000 $5425.6600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 12 12 24.000000 $1943.5200 $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 95 96 149.098622 $8934.0100 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 30 30 59.000000 $3535.2800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 38 59 117.000000 $9474.6600 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 4 5 10.000000 $809.8000 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 0.726027 $42.1900 $58.1200
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.189041 $10.9800 $58.1000
OCTH -97165 OT EVAL LOW COMPLEXITY 48 58 45.654478 $2652.9800 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 3.700000 $215.0100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 23 28 11.987668 $696.6100 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 6 6 3.607686 $209.6400 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 4 0.591781 $34.3900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 27 29 15.180821 $882.1700 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 13 14 9.326331 $541.9500 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 3 0.543836 $31.6000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 51 64 49.403184 $2870.8300 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 2.000000 $116.2200 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 13 16 7.484342 $434.9100 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 3 3 1.746575 $101.4900 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 3 2.246575 $130.5500 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 10 7.493151 $435.4300 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.500000 $145.2800 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.700000 $40.6800 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 0.744444 $43.2600 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 18.714286 $1087.4800 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.122222 $7.1000 $58.1000
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Subtotal (Total Children Is Unduplicated) 308 687 852.380347 $57728.0800 $67.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 58 68 230.808710 $1154041.5000 $4999.9900
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.153425 $10.6400 $69.3400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 40 45 63.062407 $3153.1300 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 19 20 17.108334 $855.4200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 314 418 826.452387 $41322.6700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 5 6 19.223809 $961.2000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.966667 $49.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 194 242 487.200002 $24360.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.066667 $51.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 3.000000 $150.0000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 2.300000 $115.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 4 7.133334 $178.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 277 345 682.285718 $34114.3000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 2 3.300000 $165.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 6.000000 $150.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 306 381 3024.214301 $163307.3700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 31 35 277.571428 $14988.8400 $54.0000
INTR -T1013 INTERPRETER 26 36 97.000000 $4850.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 31 60 242.904760 $2914.8500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 102 125 1112.000009 $90427.7000 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 3 3 22.142857 $1800.6600 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 2.700000 $219.5600 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 12.857143 $1045.5400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 49 54 540.307148 $43937.6900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 3 19.142857 $1556.7000 $81.3200
PHY -97110HM PT SESSION BY PT ASST 5 6 59.142858 $3851.3900 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 97 121 935.493844 $76074.2200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 8 52.000001 $4228.6300 $81.3200
TRAV -TRAVS Travel by mile 36 68 6885.161907 $3063.9000 $0.4500
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Subtotal (Total Children Is Unduplicated) 422 2060 15634.700573 $1671945.0800 $106.9400
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Total 2754 16491.480920 $1729673.1600 $104.8800
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Number of Children (Unduplicated) With at Least One Authorization 501