Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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 2504 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 45 49 45.052383 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 5 5 3.333333 $152.2700 $45.6800
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Subtotal (Total Children Is Unduplicated) 50 54 48.385716 $152.2700 $3.1500
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 4 4 4.000000 $200.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 2.011111 $162.8600 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 10.011111 $810.7000 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 3.000000 $242.9400 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 2.022222 $163.7600 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 0.504110 $40.8200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 17 17 28.000000 $1677.7600 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 9 9 7.548554 $452.3100 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 72 72 141.500000 $11458.6700 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 28 28 80.285714 $6501.5400 $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 20 20 39.500000 $3198.7100 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 34 35 69.500000 $5628.1100 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 10 10 19.500000 $1579.1100 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 49 50 125.499999 $7519.9600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 85 85 169.500000 $10156.4400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.094444 $5.4900 $58.0800
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.027778 $1.6200 $58.1600
OCTH -97165 OT EVAL LOW COMPLEXITY 17 18 12.783332 $742.8300 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.511111 $29.7000 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 9 7.544445 $438.4100 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 0.533333 $30.9900 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 4 5 1.577777 $91.6800 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.327778 $19.0500 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.316667 $18.4000 $58.1200
PSTH -97161 PT EVAL LOW COMPLEXITY 16 17 13.714286 $796.9400 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.511111 $29.7000 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.138889 $8.0700 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 12 14 7.366667 $428.0800 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 1.794444 $104.2700 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 6 7 5.344444 $310.5600 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 6.088888 $353.8200 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 1.294444 $75.2200 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 3 3.511111 $204.0300 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.394444 $22.9200 $58.1000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 26 27 20.205554 $1174.1400 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.305556 $17.7600 $58.1200
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 6.000000 $348.6600 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 2.666666 $154.9600 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 10.257143 $596.0400 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.433333 $83.2900 $58.1100
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Subtotal (Total Children Is Unduplicated) 266 495 827.126466 $57406.3200 $69.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 30 23.583485 $117918.0000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 42 47.807142 $2390.3500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 13 15 12.772222 $638.6100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 3.066667 $76.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 285 354 574.011909 $28700.6300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 94 116 205.445241 $10272.2700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 84 105 164.811904 $8240.5900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 86 103 150.957145 $7547.8800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 104 131 181.085717 $9054.3000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 59 76 134.073813 $6703.7000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.900000 $47.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 159 186 232.200791 $11610.0200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 102 119 175.103178 $8755.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 9.033333 $225.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 29 96.595242 $2608.0800 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 357 457 3211.792829 $173437.0700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 49 61 503.028566 $27163.6000 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3 3 10.142857 $121.7100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 21 29 217.720633 $17705.0500 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 3 3 21.071429 $1713.5300 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 10.000000 $813.2000 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 8.000000 $650.5600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 34 44 364.285714 $29623.7400 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 6 7 64.571429 $5250.9500 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 32 242.490473 $19719.3500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 5.776190 $469.7200 $81.3200
TRAV -TRAVS Travel by mile 1 1 1.000000 $0.4500 $0.4500
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Subtotal (Total Children Is Unduplicated) 430 1955 6672.327909 $491458.5100 $73.6600
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Total 2504 7547.840091 $549017.0900 $72.7400
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Number of Children (Unduplicated) With at Least One Authorization 548