Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 2053 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 14 15 19.522223 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.600000 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 15 16 21.122223 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 12 8.022222 $389.0800 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 5.000000 $97.5500 $19.5100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 64 67 34.399996 $759.2000 $22.0700
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $189.0300 $52.9300
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 77 85 50.993647 $1434.8600 $28.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 11 8.555556 $42778.0000 $5000.0300
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 5.861112 $1357.5700 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 10 14.970636 $748.5300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 2 1.250000 $62.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 7 5.030555 $251.5300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 2 1.866666 $93.3300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 89 101 114.997621 $5749.8900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 4 5 10.000000 $500.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 4.483334 $112.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 37 46 58.622222 $2931.1100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 2 2 3.500000 $175.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 36 42 55.934129 $2796.7100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.866667 $71.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 21 26 118.642857 $5932.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 419 504 3219.128583 $160956.2100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 38 42 253.747624 $12687.3600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 597 922 5030.836535 $50308.3100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 27 33 195.511907 $14069.0400 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 4.571429 $328.9600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 25 32 201.647620 $14510.5500 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 32.085715 $2308.8800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 30 34 212.076192 $15261.0000 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 30 31 237.450002 $17086.8700 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 3 5 48.857143 $3515.7700 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 36 39 262.231744 $18870.1900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 5 49.428571 $3556.8800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 26 32 203.438097 $14639.3800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.611111 $115.9300 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 636 1952 10359.203628 $391775.4000 $37.8200
-------------------------------------------------------------------------------------------------------------------------------------
Total 2053 10431.319498 $393210.2600 $37.7000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 648