Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 3863 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 82 87 57.669046 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 82 87 57.669046 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.422222 $20.4800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 2.571429 $143.2500 $55.7100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 2 0.511111 $26.0900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 6 2.166667 $110.6100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 98 119 80.170631 $4092.7000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 5 1.533334 $78.2800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 68 92 28.811111 $1470.8100 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.072222 $3.6900 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 28 34 10.566665 $539.4200 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $26.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.511111 $26.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 37 40 40.548411 $1806.4300 $44.5500
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Subtotal (Total Children Is Unduplicated) 177 306 168.907136 $8370.0300 $49.5500
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.022222 $235.1100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 51 141 101.330155 $5066.5100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.005556 $0.2800 $50.4000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.477778 $11.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 0.261111 $13.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 6.268255 $156.7100 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.644444 $16.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 0.005556 $0.2800 $50.4000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 10.780952 $269.5200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 139 183 1550.071427 $38751.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1104 1363 12005.383278 $600270.0600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 6.714285 $335.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1079 1352 11853.552324 $118535.7000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 79 103 801.192849 $57237.3600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 66 74 618.638099 $35386.1300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 59 86 618.368253 $44176.3000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 2 6.571428 $469.4700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 46 50 414.071433 $23668.3200 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 2 13.142857 $751.2500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 47 61 408.988097 $29218.1600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 6.571428 $375.8800 $57.2000
SPL -92508HA GROUP SPL SESSION PER CHILD 29 34 231.428573 $3212.2300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1277 3470 28655.490360 $958157.9100 $33.4400
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Total 3863 28882.066542 $966527.9400 $33.4600
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Number of Children (Unduplicated) With at Least One Authorization 1340