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 1255 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 426 438 464.144443 $10902.7500 $23.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
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Subtotal (Total Children Is Unduplicated) 432 445 471.144443 $11219.7500 $23.8100
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 307 328 478.273003 $23913.5900 $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 38 40 415.611110 $20780.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 64.401586 $4600.8600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 9 10 47.796826 $2733.9800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 15 16 123.428570 $8817.7500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 32 250.209525 $17874.9700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.714286 $269.6600 $57.2000
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Subtotal (Total Children Is Unduplicated) 387 810 1797.584103 $99591.2900 $55.4000
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Total 1255 2268.728546 $110811.0400 $48.8400
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Number of Children (Unduplicated) With at Least One Authorization 728