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 1394 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 44 48 44.074605 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 44 48 44.074605 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 4 4 4.000000 $200.0000 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 0.011111 $0.9000 $80.9000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 2.000000 $119.8400 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 0.011111 $0.6700 $59.8600
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $485.8800 $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 -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 4.285714 $256.8000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $479.3600 $59.9200
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.444444 $25.8200 $58.1000
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
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Subtotal (Total Children Is Unduplicated) 18 26 36.752380 $2403.8100 $65.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 4.276712 $21383.5000 $4999.9900
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 1 2 3.066667 $82.8000 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 25 34 232.461901 $12552.9600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 12 74.676190 $4032.5200 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3 3 10.142857 $121.7100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 3 16.428571 $1335.9700 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.714286 $58.0900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 1 1 3.857143 $313.6600 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 2 4.857143 $394.9800 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 3.142857 $255.5800 $81.3200
TRAV -TRAVS Travel by mile 1 1 1.000000 $0.4500 $0.4500
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Subtotal (Total Children Is Unduplicated) 356 1320 2246.893389 $134795.7300 $59.9900
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Total 1394 2327.720374 $137199.5400 $58.9400
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Number of Children (Unduplicated) With at Least One Authorization 396