Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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 3134 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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 46 59 34.784855 $1687.0700 $48.5000
EXIT -EXIT EXIT ASSESSMENT 27 27 30.002740 $1500.1400 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 2 3.066666 $153.3300 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 2 0.511111 $26.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.483333 $24.8500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 76 98 81.848705 $4187.0700 $51.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 0.941476 $4707.0000 $4999.6000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.085388 $54.2700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 31 35 54.405265 $2720.2700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 4.500000 $225.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 6.133334 $153.3400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 325 453 936.561938 $46828.2700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 2.633333 $131.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 153 197 399.413976 $19970.7800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 2.000000 $100.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.133334 $153.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 45 84.092859 $4204.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 293 373 733.190507 $36659.6700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 3 5.066667 $253.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 12.000000 $300.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 10 11 79.857144 $3992.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2 2 14.071429 $703.5700 $50.0000
INTR -T1013 INTERPRETER 21 36 126.255480 $6312.7700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 358 901 4709.076937 $47090.8400 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 2 26.285714 $1891.5200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 1.142857 $82.2400 $71.9600
TRAV -TRAVS Travel by mile 361 956 246143.301475 $109533.7700 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 394 3036 253348.149113 $286069.1500 $1.1300
-------------------------------------------------------------------------------------------------------------------------------------
Total 3134 253429.997818 $290256.2200 $1.1500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 404