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 1362 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 45 54 51.123395 $2479.4900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 2.000000 $123.4200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 2 0.500000 $7.6000 $15.1900
EXIT -EXIT COS Exit 7 7 4.008220 $200.4100 $50.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
OCTH -97165 OT EVAL LOW COMPLEXITY 2 3 1.500000 $87.1700 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.500000 $29.0600 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.098630 $5.7300 $58.0900
SPCH -92521 EVAL OF SPEECH FLUENCY 1 2 0.500000 $29.0600 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.500000 $29.0600 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.098630 $5.7300 $58.0900
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Subtotal (Total Children Is Unduplicated) 59 78 68.828875 $3518.1800 $51.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.613242 $3066.5000 $5000.4700
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 191 238 479.933336 $23996.6800 $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 276 344 679.552385 $33977.6400 $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 11 15 122.000002 $6587.9800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 9.428571 $509.1400 $54.0000
INTR -T1013 INTERPRETER 26 36 97.000000 $4850.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 31 58 239.838094 $2878.0500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 61.857144 $5030.2100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 1 1 5.142857 $418.2200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 9.142857 $595.3900 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 5 37.428572 $3043.6900 $81.3200
TRAV -TRAVS Travel by mile 36 67 6883.628574 $3063.2100 $0.4500
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Subtotal (Total Children Is Unduplicated) 365 1277 9577.179239 $135168.2900 $14.1100
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Total 1362 9650.408114 $138686.4700 $14.3700
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Number of Children (Unduplicated) With at Least One Authorization 386