Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3609 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
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 474 490 516.144443 $12124.2300 $23.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 42 42 41.744444 $2131.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 20 20 31.753968 $1621.0400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $153.1500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 50 50 47.033333 $2401.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 17 18 18.022222 $802.8900 $44.5500
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Subtotal (Total Children Is Unduplicated) 549 625 659.698410 $19308.1700 $29.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 308 329 479.906336 $23995.2600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 7.666667 $383.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.022222 $25.5600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 40 43 45.544443 $2277.2200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 154 161 158.820632 $7941.0200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 1.022222 $51.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 156 163 184.652377 $9232.6000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.277777 $31.9400 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 13.142857 $657.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 919 1038 11302.810640 $565140.8100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 50.571428 $2528.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 162 170 1316.733352 $94067.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 139 155 1046.153974 $59840.0300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 411 457 2864.600045 $204646.9800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 6 6 35.428572 $2531.0100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 30.571429 $1747.4600 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 6.571429 $469.4600 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 19.714286 $1408.3900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 380 429 3388.626999 $242083.6900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $938.9300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 23.500000 $1344.2100 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 2 26.714286 $1528.0600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 7 9 76.142856 $1056.8700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1391 2984 21095.337686 $1228927.0200 $58.2600
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Total 3609 21755.036096 $1248235.1800 $57.3800
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Number of Children (Unduplicated) With at Least One Authorization 1410