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: 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 3298 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 72 79 58.049200 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 72 79 58.049200 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.1000 $56.1000
OCTH -97165TL OT EVAL LOW COMPLEXITY 3 3 0.927778 $47.7000 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 0.633333 $32.5600 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 4 0.994445 $51.1300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 75 84 53.542850 $2752.6100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.116667 $6.0000 $51.4200
PSTH -97163TL PT EVAL HIGH COMPLEXITY 44 53 17.966665 $923.6600 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.1100 $15.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 61 67 57.103958 $2935.6700 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.500000 $25.7100 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 12.857143 $660.9800 $51.4100
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Subtotal (Total Children Is Unduplicated) 125 220 147.665061 $7559.7600 $51.2000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 50 120 37.277775 $1863.8800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 12 11.355554 $567.7700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 12 12.277777 $613.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 3.733332 $186.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 9.793651 $489.6800 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 14.142857 $353.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 147 195 1601.571421 $40039.3600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 818 914 9622.285683 $481114.7900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 236 238 1642.142863 $82107.1900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 971 1148 11190.753150 $134289.1700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 4.500000 $323.8200 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 129 148 1181.126194 $84993.9300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 3 3 12.785715 $920.0600 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 74 87 672.928576 $48423.9300 $71.9600
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 4.642857 $334.1000 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 92 109 770.214287 $55424.6700 $71.9600
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Subtotal (Total Children Is Unduplicated) 1146 2999 26792.531692 $932064.5800 $34.7900
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Total 3298 26998.245953 $939624.3400 $34.8000
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Number of Children (Unduplicated) With at Least One Authorization 1198