Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-25 and 12-31-25 Date of Report: 01-07-26 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 7025 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 146 162 157.599997 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 146 162 157.599997 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 25 30 23.268494 $1128.5200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 7.000000 $431.9700 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 3.066667 $46.5800 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $24.2800 $24.2800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 8.571429 $198.3400 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.166667 $9.1500 $54.9100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 1.644444 $133.5900 $81.2400
EXIT -EXIT COS Exit 137 140 119.157926 $5957.9000 $50.0000
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 1 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 2 4.000000 $323.9200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $838.8800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $359.5200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 5 10.000000 $809.8000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 8 13 26.000000 $2105.4800 $80.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $116.2200 $58.1100
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Subtotal (Total Children Is Unduplicated) 184 220 243.875627 $13941.7900 $57.1700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 9 8.511111 $42555.5000 $4999.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 251 259 291.919113 $14595.9500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 60 64 54.845435 $2742.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 41 39.995598 $999.8900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 299 401 884.117863 $44206.0100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 49 64 201.477781 $10073.9100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 12 15 35.666668 $891.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 88 102 220.838158 $11041.9500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 19 22 54.700000 $2735.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 10 25.700001 $642.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 105 131 261.878859 $13094.0200 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 17 19 39.933335 $1996.6800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 5 11.066666 $276.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 142 171 351.996040 $17599.8500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 20 21 47.866666 $2393.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 15 16 61.281803 $1532.0600 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 2 13.142857 $657.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 68 78 653.709518 $35300.3400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 13 16 96.304761 $5200.4700 $54.0000
INTR -T1013 INTERPRETER 217 302 673.899995 $33695.0300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1607 2407 18019.129479 $216229.8100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 3 15.838096 $1287.9500 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 6.133333 $498.7600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 7 9 93.990476 $7643.3100 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 10.285714 $836.4300 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 13.142857 $1068.7800 $81.3200
RSPT -RSPT RESPITE 1 1 13.142857 $0.0000 $0.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 12 60.428570 $4914.0500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $1068.7800 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 26.285714 $2137.5500 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 9.428571 $148.5900 $15.7600
TRAN -TRAN *FAMILY TRANSPORTATION 2 2 16.209524 $1620.9600 $100.0000
TRAV -TRAVS Travel by mile 1625 2455 18082.096940 $8046.5400 $0.4500
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Subtotal (Total Children Is Unduplicated) 1727 6643 40408.107216 $487731.7300 $12.0700
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Total 7025 40809.582840 $501673.5200 $12.2900
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Number of Children (Unduplicated) With at Least One Authorization 1843