Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 1524 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 87 95 67.661104 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 87 95 67.661104 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 12 16 23.249207 $1127.5900 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.166667 $33.7400 $28.9200
OCTH -97165 OT EVAL LOW COMPLEXITY 21 24 9.922223 $510.1100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 25 27 16.261110 $835.9800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 46 55 32.433335 $1667.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 92 111 84.552379 $4346.8300 $51.4100
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Subtotal (Total Children Is Unduplicated) 173 235 167.584921 $8521.6500 $50.8500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 17 13.916667 $69583.5000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 27 31 46.433334 $2321.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 103 133 205.333335 $10266.6800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 63 85.022219 $4251.1000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 100 121 227.258729 $11362.9400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 412 571 3238.761911 $161938.2300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 7.571429 $378.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 23 39 220.047616 $15834.6500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 70 96 510.826981 $36759.1600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 93 122 686.873012 $49427.4000 $71.9600
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Subtotal (Total Children Is Unduplicated) 583 1194 5242.045233 $362123.8700 $69.0800
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Total 1524 5477.291258 $370645.5200 $67.6700
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Number of Children (Unduplicated) With at Least One Authorization 660