Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 1569 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 87 97 60.253967 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 87 97 60.253967 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 15 13.605556 $659.8700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 2.000000 $57.8400 $28.9200
OCTH -97165 OT EVAL LOW COMPLEXITY 33 45 23.033335 $1184.1500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 24 28 15.800000 $812.2800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 28 34 15.588887 $801.4200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 7.142858 $367.2100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 68 90 43.776485 $2250.5500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.183333 $8.2200 $44.8500
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Subtotal (Total Children Is Unduplicated) 147 218 122.130454 $6192.9600 $50.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 14 10.396575 $51983.0000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 19 19 26.366668 $1318.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 108 143 169.122227 $8456.1400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 52 71 93.000000 $4650.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 94 116 159.449211 $7972.4800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 427 660 3229.133337 $161456.6200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 35 54 258.912698 $18631.3400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 52 74 359.366667 $25860.0100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 68 103 424.490474 $30546.3300 $71.9600
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Subtotal (Total Children Is Unduplicated) 566 1254 4730.237857 $310874.2500 $65.7200
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Total 1569 4912.622278 $317067.2100 $64.5400
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Number of Children (Unduplicated) With at Least One Authorization 641