Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2924 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 1 1 0.084932 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.084932 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 32 48 36.725875 $1781.2100 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.494444 $24.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 55 55 60.759686 $3037.9900 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.455556 $20.3000 $44.5500
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Subtotal (Total Children Is Unduplicated) 90 110 103.435561 $5119.4700 $49.4900
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.166667 $108.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 40 40 47.713777 $2385.7000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 5 7.000000 $350.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 5.822223 $145.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 345 485 1117.660750 $55883.2100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 6.133334 $306.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.800000 $45.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 168 216 457.614303 $22880.7900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 30 32 87.919052 $4395.9800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.133333 $153.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 44 110.619054 $5530.9800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 5 7.266666 $181.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 298 386 805.238127 $40262.0600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 7 9 16.866668 $843.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.100000 $77.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 5 51.857143 $2592.8600 $50.0000
INTR -T1013 INTERPRETER 16 26 107.483821 $5374.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 353 757 4566.409528 $45664.1800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 15.000000 $1071.6000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 1.000000 $71.4400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 6.714286 $479.6700 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 11.714286 $162.5900 $13.8800
TRAV -TRAVS Travel by mile 349 783 229034.564821 $101920.3800 $0.4500
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Subtotal (Total Children Is Unduplicated) 401 2813 236477.797839 $290887.0500 $1.2300
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Total 2924 236581.318332 $296006.5100 $1.2500
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Number of Children (Unduplicated) With at Least One Authorization 411