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 1249 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 -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $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 2 2 4.000000 $239.6800 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 1.000000 $80.9800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 5.000000 $299.6000 $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
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.066667 $3.8800 $58.1400
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 8.000000 $464.8800 $58.1100
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Subtotal (Total Children Is Unduplicated) 12 21 42.066667 $2860.4400 $68.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 11 8.498630 $42493.0000 $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 2 2 4.233333 $114.3000 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 17 19 105.433335 $5693.3900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 25.214286 $1361.5700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 2 12.857143 $1045.5400 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 2 13.000000 $1057.1600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 1 1 4.000000 $325.2800 $81.3200
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Subtotal (Total Children Is Unduplicated) 333 1169 1721.684268 $129316.3600 $75.1100
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Total 1249 1827.273154 $132176.7900 $72.3400
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Number of Children (Unduplicated) With at Least One Authorization 384