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: 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 3383 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 16 17 13.404761 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 7.805556 $288.8100 $37.0000
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Subtotal (Total Children Is Unduplicated) 24 25 21.210317 $288.8100 $13.6200
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $23.5000 $23.5000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 1.155556 $59.0200 $51.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 6.000000 $270.0000 $45.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.655556 $33.4700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 8 8 5.127778 $261.7700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 53 55 38.529366 $1966.9300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 6 7 2.972222 $151.7300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 5.011112 $255.8200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 4.346824 $221.9000 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 45 46 41.924605 $2140.2600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 17 17 22.287302 $992.9000 $44.5500
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Subtotal (Total Children Is Unduplicated) 91 167 132.010321 $6535.1100 $49.5000
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.188889 $13.0100 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 4.000000 $920.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 6 2.877778 $143.8900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 489 605 808.334906 $40416.7700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.033333 $25.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 75 96 175.642055 $8782.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 575 702 771.165069 $38558.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.066667 $1.6700 $25.0100
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 15.571428 $389.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 83 86 792.428568 $19810.7100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 16.285714 $814.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 792 988 8375.336517 $418766.5100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 0.714286 $35.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 463 472 4278.841303 $42788.3500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 83 85 490.417458 $35035.4600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 25.071429 $1434.0800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 31 33 176.246034 $12591.0000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 30.714286 $1755.6200 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 85 88 527.964284 $37717.8000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 28.000000 $1601.6000 $57.2000
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 6.428571 $89.2300 $13.8800
TRAV -TRAVS Travel by mile 2 2 9.933333 $4.4200 $0.4400
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Subtotal (Total Children Is Unduplicated) 866 3191 16538.261908 $661745.6100 $40.0100
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Total 3383 16691.482546 $668569.5200 $40.0500
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Number of Children (Unduplicated) With at Least One Authorization 874