Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3192 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 2 2 4.541270 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 4.541270 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 33 41 21.641780 $1049.6300 $48.5000
EXIT -EXIT EXIT ASSESSMENT 19 19 28.428571 $1421.4300 $50.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.000000 $150.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.500000 $25.7100 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 10.285714 $528.7900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.500000 $25.7100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 2 2.000000 $102.8200 $51.4100
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Subtotal (Total Children Is Unduplicated) 56 68 70.356065 $3604.0800 $51.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.180822 $9.0400 $49.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 44 69.895400 $3494.7800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 4 6.005556 $300.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.966667 $49.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 306 420 870.426552 $43521.3300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 3.300000 $165.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 162 206 410.127532 $20506.4000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 7.066667 $176.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 38 71.228570 $3561.4200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 290 365 716.626553 $35831.3500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 3.000000 $150.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 6.133334 $153.3400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 9 102.857143 $5142.8500 $50.0000
INTR -T1013 INTERPRETER 28 44 140.000001 $7000.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 360 930 4690.767407 $46907.6300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 10.285714 $740.1600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 1 1 25.714286 $1850.4000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 2 25.714286 $1850.3900 $71.9600
TRAV -TRAVS Travel by mile 391 1043 251797.335393 $112049.8100 $0.4500
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Subtotal (Total Children Is Unduplicated) 417 3122 258959.631883 $288460.0000 $1.1100
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Total 3192 259034.529218 $292064.0800 $1.1300
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Number of Children (Unduplicated) With at Least One Authorization 422