Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 1827 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 50 54 3043.515873 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 1418.755556 $52777.7100 $37.2000
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Subtotal (Total Children Is Unduplicated) 58 62 4462.271429 $52777.7100 $11.8300
Screening, Eval, and Assessment, Class # 02
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 4 8.000000 $647.8400 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 20 21 42.000000 $3401.1600 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 26.000000 $2105.4800 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 18 23 16.607144 $965.0400 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.138889 $8.0700 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 6 4.650000 $270.2100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 9 2.738889 $159.1600 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 3 0.588889 $34.2200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.150000 $8.7200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.277778 $74.2500 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 5 6 29.855555 $1734.9000 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 26 8.461113 $491.6900 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 3.714286 $215.8400 $58.1100
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Subtotal (Total Children Is Unduplicated) 72 129 169.182543 $11949.7300 $70.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 18 18 12.794445 $639.7300 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 1 0.500000 $25.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 10.666666 $266.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 257 303 202.519851 $10126.0400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.877778 $43.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 186 222 298.934129 $7473.3600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 133 246 175.966665 $8798.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 69 144 175.572221 $4389.3000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 29 70 47.133334 $2356.6700 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 0.855556 $42.7800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 33 45.533334 $1138.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 211 248 169.458737 $8472.9700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 0.877778 $43.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 173 206 284.011908 $7100.3100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 24 25 149.714288 $8084.5500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 22.000000 $1188.0000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 23 186.142859 $15137.1000 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 10 12 80.571429 $5246.8100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 10 13 90.567462 $7364.9300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 4 7 54.571429 $3553.7000 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 35 43 264.571431 $21514.9200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 3 7.857144 $638.9400 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 12.857143 $1045.5400 $81.3200
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Subtotal (Total Children Is Unduplicated) 417 1636 2296.555587 $124691.7500 $54.3000
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Total 1827 6928.009559 $189419.1900 $27.3400
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Number of Children (Unduplicated) With at Least One Authorization 469