Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 1649 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 8 8 5.877778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 5.877778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 2.000000 $90.6400 $45.3200
OCTH -97165 OT EVAL LOW COMPLEXITY 17 18 17.233333 $1001.4300 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 4 4.000000 $232.4400 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 12 14 15.000000 $871.6500 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 6.000000 $348.6600 $58.1100
SCREEN-T1023 SCREENING 23 23 23.000000 $1241.5400 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 17 17 17.800000 $1034.3600 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 13 16 72.676192 $4223.2200 $58.1100
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Subtotal (Total Children Is Unduplicated) 81 104 162.709525 $9334.4800 $57.3700
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 259 364 1060.766667 $53038.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 6.000000 $150.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 138 185 600.300001 $30015.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 3.000000 $75.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 75 116 411.733332 $20586.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 119 142 468.666666 $23433.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 11 12 41.800001 $1045.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 387 505 2559.934532 $138236.3600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 0.066667 $3.6000 $54.0300
INTR -T1013 INTERPRETER 2 2 10.809524 $540.4800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 51 69 281.742855 $22911.3200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 5 5 22.438096 $1461.1800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 46 60 273.757146 $22261.9200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 3 7.285714 $592.4700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 7 11 64.609525 $4207.3700 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 1 2 12.857143 $837.2600 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 48 58 305.333335 $24829.6800 $81.3200
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Subtotal (Total Children Is Unduplicated) 461 1537 6131.101204 $344224.9600 $56.1400
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Total 1649 6299.688507 $353559.4500 $56.1200
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Number of Children (Unduplicated) With at Least One Authorization 482