Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 7064 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 111 116 108.642855 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 111 116 108.642855 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 49 61 72.255646 $3504.4300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 6 4.358904 $244.5300 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 12.571429 $199.1300 $15.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $21.0400 $21.0400
EXIT -EXIT COS Exit 67 69 49.766440 $2488.3100 $50.0000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 6.857143 $352.5200 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 13.142857 $675.6800 $51.4100
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Subtotal (Total Children Is Unduplicated) 135 169 209.952419 $10821.1000 $51.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 10 10.823484 $54117.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 250 281 312.076030 $15603.8100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 27 29 19.928085 $996.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 32 34 51.655480 $1291.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 329 408 1106.598433 $55330.0400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 16 18 53.300002 $2665.0100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 11 6.933334 $173.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 151 179 465.052391 $23252.6800 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 9 11 36.276190 $1813.8100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 34.409524 $860.2400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 128 156 414.363506 $20718.2500 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 7 9 16.077777 $803.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 7 22.609522 $565.2400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 173 207 523.807947 $26190.4500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 14 15 21.711111 $1085.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 8 16.733333 $418.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 70 76 783.904763 $39195.2700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 76 85 913.266667 $45663.3700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 18 23 166.152382 $8307.6200 $50.0000
INTR -T1013 INTERPRETER 132 197 669.195235 $33459.7800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1578 2467 20046.557169 $240558.8700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 8 43.700001 $3144.6600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 13 16 154.038095 $11084.5800 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 9.142858 $657.9200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 14 77.895238 $5605.3500 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.714286 $123.3600 $71.9600
TRAV -TRAVS Travel by mile 1589 2499 20116.957171 $8952.0600 $0.4500
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Subtotal (Total Children Is Unduplicated) 1667 6779 46094.880014 $602638.7200 $13.0700
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Total 7064 46413.475288 $613459.8300 $13.2200
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Number of Children (Unduplicated) With at Least One Authorization 1760