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 1928 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 70 74 4171.709523 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 2498.066666 $92928.0800 $37.2000
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Subtotal (Total Children Is Unduplicated) 78 82 6669.776189 $92928.0800 $13.9300
Screening, Eval, and Assessment, Class # 02
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 5 10.000000 $809.8000 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 4.000000 $323.9200 $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 4 4 8.000000 $479.3600 $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 8 8 16.000000 $1295.6800 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $479.3600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 19 19 19.715083 $1145.6700 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 8 8 6.311111 $366.7400 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 9 9 1.977779 $114.9400 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 0.594445 $34.5500 $58.1200
SPCH -92521 EVAL OF SPEECH FLUENCY 3 4 2.705556 $157.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 15 15 4.983337 $289.6000 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 13.000000 $755.4300 $58.1100
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Subtotal (Total Children Is Unduplicated) 63 96 125.287311 $8555.3000 $68.2900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $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 265 326 215.644433 $10782.1700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 4 4 2.366667 $118.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 193 238 317.236502 $7930.9000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 129 271 179.983323 $8999.1200 $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 223 279 177.227768 $8861.3400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 4 4 2.166667 $108.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 182 226 298.264275 $7456.5800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 20 24 169.714286 $9164.5600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 38.000000 $2052.0000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 17 18 143.000001 $11628.7600 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 13 16 128.428572 $8363.2700 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 8 8 59.571429 $4844.3500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 8 9 90.428572 $5888.7100 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 25 27 251.000001 $20411.3200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.000000 $1057.1600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $185.8700 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.428571 $34.8500 $81.3300
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Subtotal (Total Children Is Unduplicated) 438 1750 2405.480113 $122442.1900 $50.9000
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Total 1928 9200.543613 $223925.5700 $24.3400
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Number of Children (Unduplicated) With at Least One Authorization 507