Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 04-01-24 and 06-30-24 Date of Report: 04-12-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 609 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 42 43 53.023810 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 43 53.023810 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 23 19.244446 $933.3600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.288889 $79.5400 $61.7100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 7 4.561111 $110.7400 $24.2800
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $54.9000 $54.9000
EXIT -EXIT COS Exit 2 2 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 29 35 28.094446 $1278.5400 $45.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 16 15.377778 $76889.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 26 16.500000 $825.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 2.700000 $67.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 10.783333 $539.1700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 65 73 146.473806 $7323.6800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 6.883334 $172.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 73 84 128.684922 $6434.2600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 88 102 183.003179 $9150.1700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.133333 $56.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 12 14.811112 $370.2800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 36 41 286.600001 $15476.3900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 24.666667 $1332.0000 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 106 139 845.327784 $10143.9300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 7.390476 $600.9900 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 3 3 11.285714 $917.7500 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 7.633333 $620.7400 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 2.366667 $192.4600 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 7 24.638096 $2003.5700 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 4 26.414285 $2148.0100 $81.3200
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Subtotal (Total Children Is Unduplicated) 313 531 1763.673820 $135313.6500 $76.7200
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Total 609 1844.792076 $136592.1900 $74.0400
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Number of Children (Unduplicated) With at Least One Authorization 355