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 1582 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
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.505556 $25.9900 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.588889 $30.2800 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.372222 $19.1300 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.500000 $25.7100 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 3 3 1.383334 $71.1200 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.172222 $8.8500 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.133333 $6.8500 $51.4000
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Subtotal (Total Children Is Unduplicated) 6 11 3.655556 $187.9300 $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 18 20 28.295237 $1414.7600 $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 8 8 4.134920 $206.7400 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 16.428571 $410.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8 8 66.142856 $3307.1500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 27 30 278.714286 $13935.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1000 1242 11152.178562 $133826.1700 $12.0000
PHY -97110TL PT SESSION BY LICENSED PT 4 4 12.500000 $899.5100 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 27.642857 $1989.1800 $71.9600
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Subtotal (Total Children Is Unduplicated) 1049 1466 11653.889269 $159226.9700 $13.6600
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Total 1582 11746.705136 $159414.9000 $13.5700
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Number of Children (Unduplicated) With at Least One Authorization 1129