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 537 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 15 17 13.005555 $630.7700 $48.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.288889 $16.7900 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 8 4.572222 $265.6900 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 5 3.666666 $213.0700 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 11 12 6.299999 $366.0900 $58.1100
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Subtotal (Total Children Is Unduplicated) 34 43 27.833331 $1492.4000 $53.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
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 57 71 454.914279 $24565.4200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 12 62.444445 $5077.9900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 4 6 30.085714 $2446.5800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 10 92.819047 $7548.0700 $81.3200
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Subtotal (Total Children Is Unduplicated) 231 358 1100.007931 $77475.2900 $70.4300
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Total 537 1245.263485 $78967.6900 $63.4100
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Number of Children (Unduplicated) With at Least One Authorization 348