Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 1637 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 4 4 2.744445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 2.744445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97165 OT EVAL LOW COMPLEXITY 6 6 6.000000 $308.4600 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 6.000000 $308.4600 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 4.000000 $205.6400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 4.000000 $205.6400 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 4.000000 $205.6400 $51.4100
SCREEN-T1023 SCREENING 41 43 43.000000 $2150.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 15 15 16.200000 $832.8400 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 6 6 43.161904 $2218.9600 $51.4100
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Subtotal (Total Children Is Unduplicated) 79 89 128.361904 $6538.4600 $50.9400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 5 9.833333 $491.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 237 343 1160.257145 $58012.8700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 146 199 635.857136 $31792.8200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 80 114 388.599995 $19429.9800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 138 159 524.083331 $26204.1600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 25.857143 $646.4300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 6.133333 $306.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 363 440 2762.933330 $138146.7100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 12 64.285714 $3214.2800 $50.0000
INTR -T1013 INTERPRETER 1 1 0.700000 $35.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 35 48 233.304766 $16788.6100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 19.428571 $1398.0800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 15 19 60.600000 $3490.5600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 59 68 324.991671 $23386.4000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 4 9.100000 $654.8400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 9 12 72.488095 $4172.4100 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 2 19.276190 $1109.5400 $57.5600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 0.900000 $64.7600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 81 101 532.749995 $38336.6500 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 19.133333 $1376.8300 $71.9600
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Subtotal (Total Children Is Unduplicated) 500 1544 6870.513081 $369059.2500 $53.7200
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Total 1637 7001.619430 $375597.7100 $53.6400
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Number of Children (Unduplicated) With at Least One Authorization 513