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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1820 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 95 105 62.358722 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 95 105 62.358722 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.511111 $24.7900 $48.5000
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.194444 $11.3000 $58.1000
OCTH -97167TL OT EVAL HIGH COMPLEXITY 4 4 1.333333 $77.4800 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 5 5 2.144444 $124.6100 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 0.722222 $41.9700 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.022222 $59.4000 $58.1100
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Subtotal (Total Children Is Unduplicated) 8 15 5.927776 $339.5400 $57.2800
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 47 140 41.977771 $2098.8600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 12 13 7.922223 $396.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 12 13 7.009523 $350.4800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 2.244445 $112.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 1.100001 $55.0100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.022222 $51.1100 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 13.571429 $366.4300 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 108 128 1165.571427 $62940.9100 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1082 1375 12052.408718 $144629.0700 $12.0000
OCCT -97530TL OT SESSION BY LICENSED OT 6 6 59.142857 $4809.5100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 15.714286 $1277.8900 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 4 4 29.857143 $2427.9900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 5 46.642857 $3793.0100 $81.3200
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Subtotal (Total Children Is Unduplicated) 1131 1700 13445.184902 $223540.2100 $16.6300
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Total 1820 13513.471400 $223879.7500 $16.5700
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Number of Children (Unduplicated) With at Least One Authorization 1200