Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 1193 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 79 88 57.795236 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 79 88 57.795236 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 9 6.661111 $323.0600 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 9 9 7.688889 $244.5800 $31.8100
OCTH -97167 OT EVAL HIGH COMPLEXITY 43 56 34.937302 $2030.2100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.500000 $87.1700 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 33 38 19.344444 $1124.1000 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.472222 $27.4400 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.094444 $5.4900 $58.0800
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 43 48 46.158729 $2682.2800 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 122 165 117.857141 $6582.4400 $55.8500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 11 9.811111 $49055.5000 $4999.9900
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 16 34.449207 $1722.4600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 63 77 107.722224 $5386.1200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 42 51 65.188890 $3259.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 72 86 123.830159 $6191.5100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 384 529 2855.819066 $154214.1400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 31.714286 $1712.5700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 46 64 335.476193 $27280.9200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 37 47 320.509525 $26063.7800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 42 55 324.309525 $26372.8200 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 499 940 4208.830186 $301259.2800 $71.5800
-------------------------------------------------------------------------------------------------------------------------------------
Total 1193 4384.482563 $307841.7200 $70.2100
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 566