Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 1376 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 93 102 66.022222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 93 102 66.022222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 12 13 10.055556 $487.7000 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.194444 $2.9500 $15.1900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 12 12 9.783333 $311.2100 $31.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.050000 $2.9100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 42 50 30.800004 $1789.8100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.161111 $9.3600 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 43 53 31.588894 $1835.6600 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.355556 $20.6600 $58.1200
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 38 47 60.897621 $3538.7700 $58.1100
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Subtotal (Total Children Is Unduplicated) 128 180 144.886519 $8057.1400 $55.6100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 16 14.391325 $71957.0000 $5000.0300
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 18 38.666665 $1933.3300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 80 98 153.638096 $7681.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 56 75.600000 $3780.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 69 90 141.966665 $7098.3300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 429 633 3485.823818 $188234.5000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 12.571428 $678.8600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 68 356.009528 $28950.7300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 41 58 341.242858 $27749.8700 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 39 55 313.752382 $25514.3600 $81.3200
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Subtotal (Total Children Is Unduplicated) 544 1094 4933.662765 $363578.8800 $73.6900
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Total 1376 5144.571506 $371636.0200 $72.2400
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Number of Children (Unduplicated) With at Least One Authorization 632