Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 3057 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 81 85 80.974594 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 81 85 80.974594 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.466667 $22.6400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.000000 $185.1300 $61.7100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.622222 $36.1600 $58.1100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.266667 $15.5000 $58.1200
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.055556 $3.2300 $58.1600
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.316667 $18.4000 $58.1200
OCTH -97167TL OT EVAL HIGH COMPLEXITY 51 60 21.172217 $1230.2900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.622222 $36.1600 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.100000 $5.8100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 48 54 18.522219 $1076.3100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.622222 $36.1600 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 1.533333 $89.1000 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 57 64 23.894441 $1388.4900 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.205556 $11.9500 $58.1200
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 0.933333 $54.2300 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.283334 $16.4700 $58.1200
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 6.000000 $348.6600 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 4.285714 $249.0400 $58.1100
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Subtotal (Total Children Is Unduplicated) 124 202 82.902370 $4823.7100 $58.1900
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 47 156 52.805553 $2640.2700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 4 1.455555 $72.7800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 4 3.888888 $194.4400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 5 4.844444 $242.2200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 0.100000 $5.0000 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 153 199 1719.285697 $46420.7900 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 888 998 9611.233248 $519007.2700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 5 36.000000 $1944.0100 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 895 1020 9773.615787 $117283.5500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 54.000000 $4391.2900 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 100 122 988.200786 $80360.6300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 3 3 16.714286 $1359.2100 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 82 99 828.639680 $67385.0500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 26.285714 $2137.5600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 78.857143 $6412.6700 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 118 140 1027.411113 $83549.1800 $81.3200
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Subtotal (Total Children Is Unduplicated) 1078 2770 24225.337894 $933869.1400 $38.5500
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Total 3057 24389.214858 $938692.8500 $38.4900
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Number of Children (Unduplicated) With at Least One Authorization 1151