Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 5938 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 1 1 0.833333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.833333 $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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 288 322 321.066667 $6264.0100 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 3.000000 $71.0100 $23.6700
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 462 516 533.675146 $40095.0200 $75.1300
OCTH -97165 OT EVAL LOW COMPLEXITY 101 141 138.044442 $7096.8500 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.022222 $52.5500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 16 21 19.855556 $1020.7800 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 123 163 169.614285 $8719.8700 $51.4100
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Subtotal (Total Children Is Unduplicated) 810 1168 1187.278318 $63376.1900 $53.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 11.428571 $57143.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 344 464 543.652387 $27182.6600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 38 49 68.083336 $3404.1800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 115 137 140.811109 $7040.5500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 205 250 326.844452 $16342.2600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.033333 $0.8300 $24.9800
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 38.571428 $964.2900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1186 1615 15241.589250 $762079.8800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1 1 4.285714 $214.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 399 646 5241.965092 $377211.8400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 448 713 4658.288127 $335210.2400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 553 889 7104.130291 $511213.4200 $71.9600
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Subtotal (Total Children Is Unduplicated) 1700 4769 33382.749757 $2098160.7500 $62.8500
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Total 5938 34570.861408 $2161536.9300 $62.5200
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Number of Children (Unduplicated) With at Least One Authorization 1724