Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 51
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 614 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
TCM -T1017TL TARGETED CASE MANAGEMENT 20 21 29.419049 $1343.8600 $45.6800
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Subtotal (Total Children Is Unduplicated) 20 21 29.419049 $1343.8600 $45.6800
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 24 25 25.000000 $1452.7500 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 7.000000 $406.7700 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 11.142857 $647.5100 $58.1100
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Subtotal (Total Children Is Unduplicated) 35 41 50.142857 $2913.8000 $58.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 3.033333 $75.8300 $25.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.900000 $72.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.283333 $14.1700 $49.9900
CONOP -CONOP CONSULT, OT, PHONE 4 4 9.000000 $225.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 4.142857 $207.1500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 3 2.500000 $125.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 173 203 1798.819034 $97136.3900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 9 72.099999 $3893.4100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 91 114 984.847608 $80087.9100 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 3 3 -20.171429 $-1640.3400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 8 10 99.499999 $6479.4300 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 1 2 3.066666 $249.3800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 45 55 446.009520 $36269.5600 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 2 2 10.714285 $871.2900 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 111 129 996.485706 $81034.3600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 11 79.952381 $6501.7500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $1068.7800 $81.3200
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Subtotal (Total Children Is Unduplicated) 328 552 4507.326149 $317671.5500 $70.4800
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Total 614 4586.888055 $321929.2100 $70.1800
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Number of Children (Unduplicated) With at Least One Authorization 352