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: 10-01-21 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 752 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 0.644444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.644444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 2.000000 $47.0000 $23.5000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.411111 $20.9900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 14.714286 $751.1700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 1.511111 $77.1400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 4 3.155556 $161.0900 $51.0500
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Subtotal (Total Children Is Unduplicated) 11 14 22.792064 $1108.4400 $48.6300
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 279 314 447.419844 $22371.0200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 49 54 71.100003 $3555.0200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 76 80 103.240473 $5162.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 176 188 246.577780 $12328.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.900000 $47.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 41 47 449.807936 $22490.4100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 8 113.714285 $8123.7600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.857143 $204.1100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 23.642857 $1352.3700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 17 19 114.678572 $8192.6500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 19 21 149.020635 $10646.0300 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 8.571429 $118.9700 $13.8800
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Subtotal (Total Children Is Unduplicated) 340 737 1733.530957 $94642.7300 $54.6000
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Total 752 1756.967465 $95751.1700 $54.5000
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Number of Children (Unduplicated) With at Least One Authorization 341