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 1579 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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 6 6.000000 $117.0600 $19.5100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 42 47 47.000000 $3531.1100 $75.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.000000 $150.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 20 26 25.733333 $1322.9500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 2.000000 $102.8200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 23 26 26.000000 $1336.6600 $51.4100
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Subtotal (Total Children Is Unduplicated) 81 108 109.733333 $6560.6000 $59.7900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.866667 $43.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 390 523 603.144442 $30157.2100 $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 62 72 632.523810 $31626.1700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 50 58 571.697616 $28584.8900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 86 99 686.793653 $49421.6300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 86 100 583.442059 $41984.4700 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 98 115 857.821432 $61728.7900 $71.9600
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Subtotal (Total Children Is Unduplicated) 657 1471 4563.546823 $279834.3700 $61.3200
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Total 1579 4673.280156 $286394.9600 $61.2800
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Number of Children (Unduplicated) With at Least One Authorization 687