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 458 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 83 89 64.744437 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 83 89 64.744437 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 21 25 18.044444 $875.1500 $48.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.416667 $21.4200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 2 2.000000 $102.8200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.511111 $77.6900 $51.4100
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Subtotal (Total Children Is Unduplicated) 23 30 21.972222 $1077.0800 $49.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $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 11 13 78.847618 $3942.3900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 10.714286 $771.0000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 1 2 13.142857 $945.7600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 15.696825 $1129.5500 $71.9600
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Subtotal (Total Children Is Unduplicated) 249 339 548.594434 $33248.3000 $60.6100
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Total 458 635.311093 $34325.3800 $54.0300
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Number of Children (Unduplicated) With at Least One Authorization 334