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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 6237 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
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 4 4 4.000000 $63.3600 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 66 70 70.000000 $1365.7000 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 4.000000 $94.6800 $23.6700
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 646 717 761.808220 $57234.6400 $75.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.000000 $150.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 4.571429 $235.0200 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 116 157 167.049205 $8587.9900 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.733333 $37.7000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 24 32 31.511111 $1619.9900 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 157 204 212.731744 $10936.5300 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 854 1191 1259.405042 $80325.6000 $63.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 19.142857 $95714.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.866667 $43.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 391 524 604.844442 $30242.2100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 45 51 96.228570 $4811.4300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 124 156 162.461906 $8123.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 243 294 366.566668 $18328.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 74 88 699.263096 $34963.1300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1203 1657 15409.964742 $770497.9500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 5 20.707936 $1035.4000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 447 698 5152.279359 $370757.8800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 451 675 4413.857081 $317621.2900 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 578 891 6643.061898 $478034.5400 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1743 5046 33590.245222 $2130198.1100 $63.4200
-------------------------------------------------------------------------------------------------------------------------------------
Total 6237 34849.650264 $2210523.7000 $63.4300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1755