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 523 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 10 12 19.249207 $933.5900 $48.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 1.705556 $87.6900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.505556 $25.9900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 9 6.061112 $311.6100 $51.4100
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Subtotal (Total Children Is Unduplicated) 22 28 28.521431 $1410.2800 $49.4500
EI Services, Class # 03
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 28 35 212.771428 $10638.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 47.000000 $3382.1300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 4 4 12.400000 $892.3000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 8 49.714286 $3577.4300 $71.9600
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Subtotal (Total Children Is Unduplicated) 253 400 885.933331 $46692.8200 $52.7000
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Total 523 982.115866 $48103.1000 $48.9800
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Number of Children (Unduplicated) With at Least One Authorization 342