Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 1557 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 84 90 64.955548 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 84 90 64.955548 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 23 29 21.227777 $1029.5400 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $28.9200 $28.9200
OCTH -97165 OT EVAL LOW COMPLEXITY 35 38 23.254109 $1195.4900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.183333 $9.4200 $51.4000
PSTH -97161 PT EVAL LOW COMPLEXITY 33 41 24.347620 $1251.7200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 26 36 14.166666 $728.3100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.133333 $6.8500 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 70 100 47.776334 $2456.1900 $51.4100
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Subtotal (Total Children Is Unduplicated) 155 248 132.089172 $6706.4400 $50.7700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 27 20.987900 $104939.5000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 20 23 27.600001 $1380.0100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 94 106 153.211104 $7660.5200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 57 70 85.377776 $4268.8800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 97 118 163.003967 $8150.2000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 443 635 3271.120624 $163556.0900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 37 41 305.709524 $21998.8800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 60 90 426.938094 $30722.4600 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.150685 $34.6000 $229.6300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 70 108 446.253971 $32112.4300 $71.9600
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Subtotal (Total Children Is Unduplicated) 586 1219 4900.353646 $374823.5700 $76.4900
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Total 1557 5097.398366 $381530.0100 $74.8500
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Number of Children (Unduplicated) With at Least One Authorization 662