Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 3817 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 71 75 4171.953967 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 102 114 42856.619841 $1594266.2600 $37.2000
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Subtotal (Total Children Is Unduplicated) 171 189 47028.573808 $1594266.2600 $33.9000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 45 47 75.992162 $6153.8500 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 9 9 13.147945 $1064.7300 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 13.000000 $1052.7400 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 18.000000 $1457.6400 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 19 30.454946 $1824.8600 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 6 12.000000 $719.0400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 208 208 414.285714 $33548.8600 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 29 30 60.000000 $4858.8000 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 42 42 84.000000 $6802.3200 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 6 6 10.066667 $815.2000 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 72 72 142.285714 $11522.3000 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 9 9 18.000000 $1457.6400 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 87 87 174.000000 $10426.0800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 36 36 72.000000 $4314.2400 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 84 104 55.240482 $3210.0600 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 3 4 1.788889 $103.9500 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 1.877778 $109.1200 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 62 66 43.466672 $2525.8800 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 3.000000 $174.3300 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 47 57 18.937140 $1100.4500 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 3 3 0.916667 $53.2700 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.322222 $18.7200 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 12 12 10.044444 $583.6800 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 19 21 100.650002 $5848.7800 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.411111 $23.8900 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 121 136 98.189714 $5705.8700 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 13.111111 $761.8900 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.133333 $65.8600 $58.1100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 552 1010 1493.322713 $106761.4600 $71.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 10 13 10.072222 $503.6100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 2 3 2.500000 $125.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 5.661111 $141.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 267 329 217.988877 $10899.3900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 4 4 2.366667 $118.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 194 239 317.514280 $7937.8400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 130 272 180.727767 $9036.3400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.611111 $30.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 71 146 192.016669 $4800.4200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 84 52.255550 $2612.7500 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 1.011111 $50.5600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 17 38 51.605558 $1290.1500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 224 280 177.683324 $8884.1200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 4 4 2.166667 $108.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 183 227 298.542053 $7463.5300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 295 372 3096.185721 $167194.0400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 26 27 203.142859 $10969.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 87 740.423812 $60211.2600 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 104 136 1283.428577 $83576.8400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 44 53 462.714284 $37627.9400 $81.3200
PHY -97110HM PT SESSION BY PT ASST 50 67 601.230955 $39152.1600 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 1 1 8.285714 $539.5600 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 157 193 1513.928574 $123112.6700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 6 60.142858 $4890.8200 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 19 23 148.509522 $12076.7900 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 3 4.857143 $394.9800 $81.3200
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Subtotal (Total Children Is Unduplicated) 659 2618 9637.572986 $603749.2300 $62.6500
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Total 3817 58159.469507 $2304776.9500 $39.6300
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Number of Children (Unduplicated) With at Least One Authorization 855