Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 04-01-25 and 06-30-25 Date of Report: 07-19-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 7305 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 127 145 148.049999 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 127 145 148.049999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 34 42 36.246577 $1757.9600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $123.4200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.1900 $15.1900
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 2.000000 $15.8400 $7.9200
AUDE -92650 AEP SCR AUDITORY POTENTIAL 2 2 3.733333 $204.9600 $54.9000
EXIT -EXIT COS Exit 84 90 79.255480 $3962.7700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 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
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $116.2200 $58.1100
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Subtotal (Total Children Is Unduplicated) 125 151 146.235390 $7623.5600 $52.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 11 8.526027 $42630.0000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 237 260 267.905906 $13395.3000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 63 70 62.696807 $3134.8300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 37 38 49.769407 $1244.2400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 348 426 1003.866644 $50193.2100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 45 58 113.081743 $5654.0700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 14 15 37.833332 $945.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 110 130 249.444437 $12472.1900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 23 26 53.480950 $2674.0400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 11.299999 $282.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 139 165 400.099991 $20004.9600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 18 22 43.783332 $2189.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 7 36.533333 $913.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 187 215 506.321412 $25315.9800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 19 22 57.799999 $2890.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 21.166665 $529.1600 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 2 10.142858 $507.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 65 74 619.628574 $33459.9300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 12 15 107.857142 $5824.2900 $54.0000
INTR -T1013 INTERPRETER 225 284 612.869049 $30643.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1635 2545 18747.577020 $224970.9100 $12.0000
PHY -97110 PT SESSION BY LICENSED PT 5 6 75.857143 $6168.7000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 3 26.000000 $2114.3200 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.428571 $116.1700 $81.3200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 10 62.419049 $5075.9200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 6.295238 $511.9300 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 52.000000 $4228.6400 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 13.000000 $204.8800 $15.7600
TRAV -TRAVS Travel by mile 1654 2585 18806.557974 $8368.9200 $0.4500
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Subtotal (Total Children Is Unduplicated) 1759 7009 42066.242602 $506682.1200 $12.0400
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Total 7305 42360.527991 $514305.6800 $12.1400
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Number of Children (Unduplicated) With at Least One Authorization 1845