Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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 2184 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 61 66 57.055553 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 61 66 57.055553 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 8 8 13.505479 $1093.6800 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 9.500000 $769.3100 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 11 17.000000 $1018.6400 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 7 7 10.005479 $599.5300 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 54 55 109.500000 $8867.3100 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 45 46 83.000000 $6721.3400 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 3.500000 $283.4300 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 18 18 36.000000 $2915.2800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 24 25 49.000000 $3968.0200 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 12 12 24.000000 $1943.5200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 48 48 100.357143 $6013.4000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 91 91 177.500000 $10635.8000 $59.9200
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $323.9200 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 18 19 11.726190 $681.4100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 8 9 5.494445 $319.2900 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 1.150000 $66.8300 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.305556 $17.7600 $58.1200
PSTH -97161 PT EVAL LOW COMPLEXITY 14 16 10.811110 $628.2300 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.428571 $83.0200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 11 5.761112 $334.7800 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.122222 $7.1000 $58.1000
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 0.622222 $36.1600 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 3.227778 $187.5700 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 1.238889 $71.9900 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 16 17 6.850001 $398.0600 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.205556 $70.0600 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 23.147619 $1345.1000 $58.1100
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Subtotal (Total Children Is Unduplicated) 229 425 716.959372 $49920.5800 $69.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 17 19 20.605479 $103027.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 30 36 28.572221 $1428.6100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 15 19 12.583334 $629.1700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 2.933333 $73.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 232 307 457.708729 $22885.4500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 78 96 135.757146 $6787.8700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 82 103 142.457146 $7122.8700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 57 67 100.684128 $5034.2200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 95 119 180.394446 $9019.7500 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 42 46 69.429366 $3471.4700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 142 186 169.096824 $8454.8500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 82 99 110.427779 $5521.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.977777 $49.4400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 18 19 44.752378 $1208.3100 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 293 393 2562.115893 $138354.1300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 50 63 394.235198 $21288.6800 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 28 33 254.000001 $20655.2600 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 21.571429 $1754.1900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 31 42 337.747616 $27465.6300 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 6 7 57.000001 $4635.2300 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 7.714286 $627.3300 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 27 197.214284 $16037.4500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 14.000000 $1138.4800 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 11.428571 $929.3700 $81.3200
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Subtotal (Total Children Is Unduplicated) 371 1693 5335.407365 $407624.9600 $76.4000
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Total 2184 6109.422290 $457545.5400 $74.8900
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Number of Children (Unduplicated) With at Least One Authorization 503