Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3590 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 97 105 89.160311 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 97 105 89.160311 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.505556 $28.3600 $56.1000
OCTH -97165TL OT EVAL LOW COMPLEXITY 8 8 2.588891 $133.1100 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 0.511111 $26.2800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 10 2.727778 $140.2400 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 51 63 20.628579 $1060.5600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.383334 $19.7100 $51.4200
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.372222 $19.1300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 0.505556 $25.9900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 5 1.316667 $67.6900 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 37 49 42.186512 $2168.8300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 41 51 18.819053 $967.5200 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.266667 $13.7100 $51.4200
SPCH -92522TL EVAL OF SPCH SOUND PROD 4 4 1.294445 $66.5500 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 1.094443 $56.2600 $51.4000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 0.222222 $11.4200 $51.4000
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 0.516666 $26.5600 $51.4000
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 3 26.571429 $1366.0400 $51.4100
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Subtotal (Total Children Is Unduplicated) 119 214 121.511131 $6246.4500 $51.4100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 35 132 48.936108 $2446.7900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 12.338096 $616.9100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 3.111110 $77.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 21 34.795237 $1739.7600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 2.366666 $59.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.355556 $17.7800 $50.0100
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.744444 $18.6100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 9 9 5.901587 $295.0800 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 1.857143 $46.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 124 205 1277.714285 $31942.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 149 176 1245.571429 $62278.5600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 903 1098 10148.604744 $507430.3700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1000 1242 11152.178562 $133826.1700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 5 26.857144 $1932.6400 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 96 133 994.000000 $71528.2000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 5 7 50.857144 $3659.6800 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 63 97 650.571428 $46815.1300 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 17.571429 $1264.4400 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 76 121 705.857143 $50793.4600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 2 6.500000 $467.7400 $71.9600
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Subtotal (Total Children Is Unduplicated) 1167 3271 26386.689255 $917257.5200 $34.7600
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Total 3590 26597.360697 $923503.9700 $34.7200
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Number of Children (Unduplicated) With at Least One Authorization 1241