Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 1812 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 43 45 42.592060 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 43 45 42.592060 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.1000 $56.1000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.6700 $23.6700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.450000 $3.2400 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.450000 $13.0100 $28.9200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.450000 $6.2100 $13.8100
EXIT -EXIT EXIT ASSESSMENT 13 13 16.000000 $800.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.316667 $16.2800 $51.4200
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 2 0.511111 $26.2800 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.316667 $16.2800 $51.4200
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 3 0.611111 $31.4200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 4.855556 $249.6300 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 0.511111 $26.2800 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 2.000000 $102.8200 $51.4100
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Subtotal (Total Children Is Unduplicated) 25 35 28.472223 $1371.2200 $48.1600
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 3.283333 $164.1700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 142 187 129.847035 $6492.4100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 8 17.200001 $430.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 543 725 2011.642873 $100582.2200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 252 314 725.052400 $36252.7200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 0.433333 $21.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.266667 $81.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 108 138 335.761907 $16788.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.600000 $15.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 238 291 654.021438 $32701.1200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 2 6.571429 $328.5700 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 26 29 185.166663 $9258.3400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 0.928571 $46.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 10 72.509525 $3625.4800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 9.142857 $457.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 3 21.285714 $1531.7300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 3 4 21.885714 $1574.9000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 6 41.000000 $2950.3600 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.285714 $16.4600 $57.6000
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Subtotal (Total Children Is Unduplicated) 630 1732 4241.885174 $213418.4600 $50.3100
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Total 1812 4312.949457 $214789.6800 $49.8000
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Number of Children (Unduplicated) With at Least One Authorization 672