Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 1638 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 16 19 12.055556 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.022222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 20 13.077778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 17 18 18.000000 $1045.9800 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 9.000000 $522.9900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 9 9 9.000000 $522.9900 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
SCREEN-T1023 SCREENING 26 28 28.022222 $1512.6400 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 10 10 10.000000 $581.1000 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $174.3300 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 19 23 112.531746 $6539.2300 $58.1100
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Subtotal (Total Children Is Unduplicated) 88 104 194.553968 $11189.8100 $57.5200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 4 8.383334 $419.1700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 236 329 1027.766674 $51388.3700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 3.066667 $153.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 161 196 664.366667 $33218.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 76 107 433.755558 $21687.7900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 119 141 435.788895 $21789.4800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 11 41.900000 $1047.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 403 506 2898.861872 $156538.6000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 6.133333 $331.2000 $54.0000
INTR -T1013 INTERPRETER 4 4 30.904761 $1545.2400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 51 63 278.119045 $22616.6700 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 3.066667 $249.3800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 7 7 42.533332 $2769.7700 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 3.000000 $195.3600 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 52 63 240.223808 $19535.0400 $81.3200
PHY -97110HM PT SESSION BY PT ASST 14 16 142.754759 $9296.1900 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 52 63 317.393647 $25810.4600 $81.3200
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Subtotal (Total Children Is Unduplicated) 477 1514 6578.019019 $368591.8800 $56.0300
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Total 1638 6785.650765 $379781.6900 $55.9700
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Number of Children (Unduplicated) With at Least One Authorization 505