Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 3660 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 4 4 8.187301 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 17 17 11.355554 $420.1500 $37.0000
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Subtotal (Total Children Is Unduplicated) 20 21 19.542855 $420.1500 $21.5000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 3.022222 $154.3400 $51.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 3.344444 $150.5000 $45.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 5 3.022223 $154.2900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 58 61 51.494440 $2628.7700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 6 4.266666 $217.8100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 19 20 22.415079 $1144.2900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 53 57 65.031742 $3319.8600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 19 21 16.988889 $756.8600 $44.5500
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Subtotal (Total Children Is Unduplicated) 89 178 170.585705 $8582.4300 $50.3100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 8 2.944446 $147.2300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.677778 $33.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 471 552 785.319817 $39265.8300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.522222 $13.0600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 75 84 150.798415 $7539.9100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 564 646 729.784883 $36489.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.500000 $12.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 96 105 987.714280 $24692.9100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 804 949 8605.480925 $430274.6000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 36.714285 $1835.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 759 850 8022.290446 $80223.0100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 96 102 601.928591 $43001.7100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 5 19.071429 $1090.8800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 34 36 195.428581 $13961.3700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 1.500000 $107.1600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 8 56.285715 $3217.2900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 94 101 563.500018 $40256.3500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 26.928573 $1540.3100 $57.2000
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 6.142857 $85.2600 $13.8800
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Subtotal (Total Children Is Unduplicated) 886 3461 20793.533261 $723788.0000 $34.8100
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Total 3660 20983.661821 $732790.5800 $34.9200
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Number of Children (Unduplicated) With at Least One Authorization 904