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: 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 2302 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 53 59 63.522219 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 53 59 63.522219 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 9 12 18.000000 $1350.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 11.033333 $893.4800 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 8.000000 $647.8400 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 4 5 8.011111 $648.7400 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 9.500000 $769.3100 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 10.000000 $599.2000 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 12 12 20.022222 $1199.7300 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 51 51 101.000000 $8178.9800 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 39 40 78.500000 $6356.9300 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 12 12 22.000000 $1781.5600 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 36 36 71.000000 $5749.5800 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 6 6 11.000000 $890.7800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 42 43 95.000000 $5692.4000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 81 81 159.500000 $9557.2400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 16 18 19.733336 $1146.7200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 8 6.394445 $371.5800 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 3 3 0.894445 $51.9800 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.183333 $10.6500 $58.1000
PSTH -97161 PT EVAL LOW COMPLEXITY 18 21 15.931747 $925.8000 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 6.500000 $377.7200 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.122222 $7.1000 $58.1000
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 14 7.550001 $438.7400 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 4 4 3.183333 $184.9800 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 0.161111 $9.3600 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 8 9 8.394445 $487.8000 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 1.627778 $94.5900 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 14 15 6.805556 $395.4700 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.488889 $28.4100 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 21.000000 $1220.3100 $58.1100
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Subtotal (Total Children Is Unduplicated) 230 430 730.537307 $50727.2000 $69.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 25 21.188584 $105942.5000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 42 48 43.485715 $2174.2900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 12 16 13.244446 $662.2300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 3.033333 $75.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 268 332 493.074578 $24653.6000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 76 97 144.530944 $7226.5100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 78 96 132.773803 $6638.6600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 61 71 115.784914 $5789.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 0.177778 $4.4500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 100 123 181.780154 $9088.9800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 55 63 76.588879 $3829.4000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.700000 $17.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 146 172 223.679358 $11183.9300 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 87 103 115.671417 $5783.5100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.922222 $98.0600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 22 25 70.838092 $1912.6200 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 331 445 2982.983343 $161081.1000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 50 60 452.925896 $24457.9900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 30 44 336.119047 $27333.2000 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 2 13.000000 $1057.1600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 36 44 298.928571 $24308.8900 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 2 2 12.000000 $975.8400 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 11.000000 $894.5200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 7 8 52.690476 $4284.7800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 24 132.714286 $10792.3300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 3 18.714286 $1521.8500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 26.000000 $2114.3200 $81.3200
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Subtotal (Total Children Is Unduplicated) 412 1813 5977.550122 $443903.2100 $74.2600
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Total 2302 6771.609648 $494630.4100 $73.0400
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Number of Children (Unduplicated) With at Least One Authorization 528