Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 3527 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 67 74 42.409518 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 67 74 42.409518 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 8.061111 $390.9600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 5 2.616667 $146.8000 $56.1000
OCTH -97165 OT EVAL LOW COMPLEXITY 32 33 23.920634 $1229.7600 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 21 23 6.133333 $315.3100 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 4 4 1.255555 $64.5500 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 35 39 50.652379 $2604.0300 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.211111 $10.8500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 6 7 1.466667 $75.4000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 17 18 6.333333 $325.6000 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 9 9 2.172221 $111.6700 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 21 25 8.049998 $413.8400 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 3 4 0.911111 $46.8400 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 24 26 23.120633 $1188.6300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 20 24 17.296826 $889.2300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.483333 $24.8500 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 17 18 5.738888 $295.0300 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.200000 $10.2800 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 7 2.633333 $118.1300 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.455556 $20.4400 $44.8600
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Subtotal (Total Children Is Unduplicated) 147 251 162.223800 $8308.4700 $51.2200
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 46 135 35.880955 $1794.0600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 7 6.455556 $322.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 2.766666 $69.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 13 14 22.970634 $1148.5300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 4.966667 $124.1700 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.044444 $1.1100 $24.9800
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 7.400000 $370.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.255556 $6.3900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 14 18 143.428569 $3585.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 121 175 1309.500003 $32737.5400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 4 37.999999 $1900.0100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 718 862 7787.031743 $389351.8800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 320 362 2773.965073 $138698.3500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1001 1227 10614.337287 $106143.4600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 67 71 618.571426 $44512.4300 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 16 17 110.838493 $6384.2900 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 60 66 381.257546 $27435.2700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 39 43 337.071430 $24255.6900 $71.9600
PHY -97110HM PT SESSION BY PT ASST 14 17 101.142860 $5821.7700 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 32 37 199.785719 $14376.5600 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 12.857143 $925.2000 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 50 50 380.428575 $27375.6400 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 52 61 363.071432 $26126.5900 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.571429 $472.8800 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 10 14 78.428572 $1094.8600 $13.9600
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Subtotal (Total Children Is Unduplicated) 1183 3202 25341.027777 $855974.9200 $33.7800
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Total 3527 25545.661095 $864283.3900 $33.8300
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Number of Children (Unduplicated) With at Least One Authorization 1236