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 1438 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 69 76 57.438089 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 69 76 57.438089 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167TL OT EVAL HIGH COMPLEXITY 5 5 2.194444 $112.8100 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 4 5 1.911111 $98.2500 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 3 3 1.105555 $56.8300 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 8 13 5.211110 $267.9000 $51.4100
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 2 2 3.222222 $161.1100 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 13.142857 $328.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 32 33 387.571427 $19378.6000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 9 56.857143 $2842.8700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 971 1148 11190.753150 $134289.1700 $12.0000
OCCT -97530TL OT SESSION BY LICENSED OT 4 4 46.285714 $3330.7300 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 2 3 24.428571 $1757.8800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 3.714286 $267.2800 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1027 1349 11790.619808 $165588.3900 $14.0400
-------------------------------------------------------------------------------------------------------------------------------------
Total 1438 11853.269007 $165856.2900 $13.9900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1081