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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3688 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 87 93 79.422227 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 87 93 79.422227 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 0.938889 $45.5400 $48.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 0.483333 $24.6700 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.288889 $14.7500 $51.0500
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 1.072223 $54.7400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 84 101 97.807144 $4993.0700 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.166667 $8.5100 $51.0600
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.227777 $11.6200 $51.0300
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.322222 $16.4500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 1.350001 $68.9200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 58 71 25.411113 $1297.2500 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.366667 $18.7200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 0.983333 $50.2000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 16 22 6.105556 $311.6900 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.366667 $18.7200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.105556 $5.3900 $51.0700
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 37 44 45.413493 $2023.1700 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 4.142857 $217.7900 $52.5700
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Subtotal (Total Children Is Unduplicated) 162 267 185.713498 $9189.4200 $49.4800
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 2 1.022222 $235.1100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 42 130 116.037307 $5801.8700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 6 2.777777 $138.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.711111 $17.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 4 1.622222 $81.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 9.045237 $226.1300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.511111 $25.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 0.466667 $23.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 15.434921 $385.8700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 20.714285 $517.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 124 160 1291.714293 $32292.8100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 22.000000 $1100.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1003 1260 10892.527786 $544625.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 55 56 201.857137 $10092.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1049 1310 11090.084930 $110900.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 62 77 565.214287 $40378.8400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 67 79 594.964285 $34031.9100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 45 60 451.484919 $32254.0700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.785714 $341.8900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 45 55 418.285716 $23909.1800 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 12.857143 $734.9100 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 52 72 410.265874 $29309.3700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.428571 $367.7200 $57.2000
SPL -92508HA GROUP SPL SESSION PER CHILD 28 31 248.571426 $3450.1700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1227 3328 26381.384941 $871717.7100 $33.0400
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Total 3688 26646.520666 $880907.1300 $33.0600
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Number of Children (Unduplicated) With at Least One Authorization 1289