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 1182 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 60 65 56.277775 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 60 65 56.277775 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
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 2 2 4.000000 $239.6800 $59.9200
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.122222 $7.1000 $58.1000
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.122222 $7.1000 $58.1000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 12.857143 $747.1300 $58.1100
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Subtotal (Total Children Is Unduplicated) 6 9 23.101587 $1444.7700 $62.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 1.358904 $6794.5000 $4999.9900
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 14 93.619049 $5055.4100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 32.000001 $1727.9900 $54.0000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 12.857143 $1045.5400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 9.571428 $778.3500 $81.3200
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Subtotal (Total Children Is Unduplicated) 300 1108 1562.428754 $85905.2000 $54.9800
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Total 1182 1641.808116 $87349.9700 $53.2000
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Number of Children (Unduplicated) With at Least One Authorization 350