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 3073 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
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 32 35 35.000000 $682.8500 $19.5100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 44 48 48.000000 $3606.2400 $75.1300
OCTH -97165 OT EVAL LOW COMPLEXITY 28 30 30.022222 $1543.4400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 4.000000 $205.6400 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 27 31 29.733334 $1528.5900 $51.4100
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Subtotal (Total Children Is Unduplicated) 121 148 146.755556 $7566.7700 $51.5600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 343 463 542.652387 $27132.6600 $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 1153 1560 15025.155916 $751258.1900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 116 137 1179.392859 $84869.1200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 125 144 935.400800 $67311.4000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 155 180 1427.240481 $102704.2600 $71.9600
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Subtotal (Total Children Is Unduplicated) 1329 2924 19687.252768 $1061181.0600 $53.9000
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Total 3073 19834.841657 $1068747.8300 $53.8800
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Number of Children (Unduplicated) With at Least One Authorization 1342