Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 6728 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 121 133 247.898410 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.377778 $14.0500 $37.2000
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Subtotal (Total Children Is Unduplicated) 122 134 248.276188 $14.0500 $0.0600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 41 47 57.629617 $2795.0500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.1000 $56.1000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $21.0400 $21.0400
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 4 4 3.016667 $150.8400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 9 16.285714 $1221.4300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 10 10 18.285714 $1371.4300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 16 16 32.000000 $1776.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 19 37.000000 $2775.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 5 6 12.000000 $900.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $189.0300 $52.9300
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Subtotal (Total Children Is Unduplicated) 85 121 191.789141 $11871.1400 $61.9000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 9.307502 $46537.0000 $4999.9500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.252055 $62.6100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 270 302 347.564350 $17378.2200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 15 19 3.061648 $153.0700 $49.9900
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 41 41 41.962624 $1049.0700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 244 304 710.319059 $35516.0100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 27 35 86.038892 $4301.9600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 13 15 27.909524 $697.7400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 72 84 216.744449 $10837.2600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 11 14 26.700000 $1335.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 7 12.566668 $314.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 107 130 284.841031 $14242.1100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 16 20 44.516669 $2225.8500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 4.600000 $115.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 172 213 567.603976 $28380.2300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 17 23 40.122223 $2006.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 16.466667 $411.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 63 71 590.971427 $29548.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 62 72 500.019052 $25000.9600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 6 8 62.142857 $3107.1500 $50.0000
INTR -T1013 INTERPRETER 135 164 625.807144 $31290.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1566 2438 19050.934099 $190509.4600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 50.714286 $3649.4000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 12 15 98.638094 $7097.9800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 3.714286 $267.2800 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 8 67.480953 $4855.9300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.857143 $133.6400 $71.9600
TRAV -TRAVS Travel by mile 1570 2466 19155.503145 $8524.2100 $0.4500
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Subtotal (Total Children Is Unduplicated) 1632 6473 42651.359823 $470011.2600 $11.0200
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Total 6728 43091.425152 $481896.4600 $11.1800
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Number of Children (Unduplicated) With at Least One Authorization 1731