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: 01-01-24 and 03-31-24 Date of Report: 04-04-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 4082 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 96 112 80.234121 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 96 112 80.234121 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 5 6 6.000000 $370.2600 $61.7100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.250000 $14.5300 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 1.011112 $58.7600 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.350000 $20.3400 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 82 108 42.627784 $2477.1400 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.505556 $29.3800 $58.1200
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 3 0.927778 $53.9100 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.133333 $7.7500 $58.1000
PSTH -97163TL PT EVAL HIGH COMPLEXITY 52 69 19.744449 $1147.3800 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 2.000000 $30.2200 $15.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 57 77 20.150004 $1170.9400 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.011112 $58.7600 $58.1200
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.566667 $32.9300 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 13.142857 $763.7300 $58.1100
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Subtotal (Total Children Is Unduplicated) 133 277 108.420652 $6236.0200 $57.5200
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 48 127 38.591680 $1929.6500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 16 8.855555 $442.7800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 15 12.217460 $610.8700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 9 5.455555 $272.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 5.749207 $287.4600 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 133 213 1413.142854 $38154.8800 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1049 1423 11761.106368 $635099.7500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 10 11 85.571428 $4620.8600 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1051 1432 11946.216685 $143354.6000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 3.714286 $302.0500 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 133 182 1187.159527 $96539.8100 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 12.428571 $1010.6900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 26.000000 $2114.3200 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 87 120 715.571433 $58190.2700 $81.3200
SENS -V5264 EARMOLD 1 2 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 8.714285 $708.6500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 91 128 632.676190 $51449.2300 $81.3200
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Subtotal (Total Children Is Unduplicated) 1208 3693 27867.171084 $1035588.1200 $37.1600
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Total 4082 28055.825857 $1041824.1500 $37.1300
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Number of Children (Unduplicated) With at Least One Authorization 1268