Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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 3050 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 5 5 5.488889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 5.488889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 37 42 25.287441 $1226.4500 $48.5000
EXIT -EXIT COS Exit 5 5 3.750000 $187.5000 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 2 0.243836 $12.5400 $51.4200
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 13.142857 $675.6800 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 4.338889 $223.0600 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.038356 $1.9700 $51.4700
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 13.653968 $701.9500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.038356 $53.3800 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.511111 $129.1000 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.038356 $1.9700 $51.4700
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 2.000000 $102.8200 $51.4100
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Subtotal (Total Children Is Unduplicated) 48 69 70.054128 $3578.1500 $51.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.511111 $7555.5000 $4999.9600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 45 47 56.774662 $2838.7500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 3 3 3.250000 $162.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 4.066666 $101.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 328 438 1006.129391 $50306.6100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.533333 $76.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.633333 $65.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 193 241 503.502064 $25175.1500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 2.366666 $118.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 10.666667 $266.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 16 18 37.643185 $1882.1700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.466667 $11.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 311 379 822.969863 $41148.6100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 3.066667 $153.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 12.233334 $305.8400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 54.000000 $2700.0100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 6 34.857142 $1742.8600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 4.142857 $207.1500 $50.0000
INTR -T1013 INTERPRETER 19 30 99.906913 $4995.3600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 340 813 4388.170584 $52658.1300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 11 100.000001 $7196.0100 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 5 6 64.428571 $4636.2900 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 7 66.571429 $4790.4900 $71.9600
TRAV -TRAVS Travel by mile 371 948 256977.706180 $114355.0800 $0.4500
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Subtotal (Total Children Is Unduplicated) 404 2976 264258.597286 $323450.6300 $1.2200
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Total 3050 264334.140303 $327028.7800 $1.2400
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Number of Children (Unduplicated) With at Least One Authorization 410