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 844 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
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SCREEN-T1023 SCREENING 1 1 1.000000 $53.9800 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.666667 $96.8500 $58.1100
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Subtotal (Total Children Is Unduplicated) 5 5 5.666667 $325.1600 $57.3800
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 15 19 64.419045 $3478.6300 $54.0000
INTR -T1013 INTERPRETER 4 4 30.904761 $1545.2400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 3 25.142857 $2044.6200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 1 1 0.933333 $75.9000 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 15.676191 $1274.8000 $81.3200
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Subtotal (Total Children Is Unduplicated) 273 819 2752.103982 $138123.1500 $50.1900
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Total 844 2770.848427 $138448.3200 $49.9700
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Number of Children (Unduplicated) With at Least One Authorization 291