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 428 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
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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
OCTH -97167 OT EVAL HIGH COMPLEXITY 8 11 7.788889 $452.6100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 7 4.922222 $286.0300 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
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Subtotal (Total Children Is Unduplicated) 17 29 21.372222 $1177.9300 $55.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 3.000000 $15000.0000 $5000.0000
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 42 52 299.152383 $16154.2200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 15 98.438095 $8004.9900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 6 7 54.428572 $4426.1200 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 21.285715 $1730.9500 $81.3200
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Subtotal (Total Children Is Unduplicated) 200 311 807.495245 $61875.8200 $76.6300
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Total 428 886.662703 $63053.7500 $71.1100
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Number of Children (Unduplicated) With at Least One Authorization 276