Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 1391 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 118 136 117.422223 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 118 136 117.422223 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 19 13.516667 $655.5600 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.322222 $4.8900 $15.1900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 5.411111 $172.1300 $31.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.455556 $26.4700 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 50 69 44.855556 $2606.5600 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 30 39 21.222220 $1233.2100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 62 76 66.703172 $3876.1200 $58.1100
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Subtotal (Total Children Is Unduplicated) 138 212 152.486504 $8574.9400 $56.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 15 12.274277 $61371.0000 $4999.9700
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 18 26.088889 $1304.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 84 103 203.955553 $10197.7700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 46 59 99.933334 $4996.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 67 76 126.766670 $6338.3500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 458 595 3953.409468 $213484.4500 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 50 70 414.939681 $33742.9200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 26 36 190.404761 $15483.7500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 57 71 521.699995 $42424.7200 $81.3200
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Subtotal (Total Children Is Unduplicated) 576 1043 5549.472628 $389344.0700 $70.1600
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Total 1391 5819.381355 $397919.0100 $68.3800
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Number of Children (Unduplicated) With at Least One Authorization 685