Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 1732 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 15 15 10.833333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 15 10.833333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 2.000000 $90.6400 $45.3200
OCTH -97165 OT EVAL LOW COMPLEXITY 22 22 24.033333 $1396.5800 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 5.000000 $290.5500 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 11 11 11.000000 $639.2100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 5.000000 $290.5500 $58.1100
SCREEN-T1023 SCREENING 29 29 29.000000 $1565.4200 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 11 12 12.000000 $697.3200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.857143 $224.1400 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 16 20 86.709526 $5038.7000 $58.1100
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Subtotal (Total Children Is Unduplicated) 88 109 178.600002 $10233.1000 $57.3000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 4.133333 $206.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 266 374 1139.583325 $56979.1300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.400000 $35.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 150 188 674.066662 $33703.3100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 3.033333 $75.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 81 112 452.999992 $22649.9600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 126 160 493.299996 $24664.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 11 41.266666 $1031.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 418 525 2982.932157 $161078.3900 $54.0000
INTR -T1013 INTERPRETER 4 4 45.066667 $2253.3400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 52 70 303.947622 $24717.0500 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 3.033333 $246.6700 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 7 8 65.209524 $4246.4500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 51 66 304.085714 $24728.2700 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.533333 $206.0100 $81.3200
PHY -97110HM PT SESSION BY PT ASST 9 12 69.085715 $4498.8600 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 1 1 10.857143 $707.0100 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 57 69 303.247622 $24660.0900 $81.3200
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Subtotal (Total Children Is Unduplicated) 491 1608 6900.782137 $386738.6700 $56.0400
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Total 1732 7090.215472 $396971.7700 $55.9900
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Number of Children (Unduplicated) With at Least One Authorization 521