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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3514 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 7.511111 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2 2 7.511111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 44 54 28.873212 $1400.3600 $48.5000
EXIT -EXIT EXIT ASSESSMENT 25 25 31.712264 $1585.6200 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 2.005479 $150.4100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 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 0.566667 $28.3400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.383333 $71.1200 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 13.000000 $668.3300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.033333 $1.7100 $51.3600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 2 2.000000 $102.8200 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 70 94 88.579767 $4621.4100 $52.1700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 4 1.572222 $7861.0000 $4999.9300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 42 48 77.170915 $3858.5400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 2 3 4.000000 $200.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.750000 $18.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 331 444 948.669009 $47433.2500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 2 2 1.966667 $98.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 188 228 466.927069 $23346.2400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 7.099999 $355.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 9.100000 $227.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 37 81.599997 $4079.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 321 395 795.181709 $39758.9100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.433333 $121.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 5.400000 $135.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 11 12 75.142857 $3757.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2 2 16.000000 $800.0000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 1.000000 $50.0000 $50.0000
INTR -T1013 INTERPRETER 14 24 58.843703 $2942.1900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 380 1003 5033.608609 $60403.2500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 5 29.285714 $2107.4000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 4 5 20.285714 $1459.7600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 5 38.000000 $2734.4800 $71.9600
TRAV -TRAVS Travel by mile 423 1187 295054.368435 $131299.2000 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 440 3418 302730.405952 $333097.5700 $1.1000
-------------------------------------------------------------------------------------------------------------------------------------
Total 3514 302826.496830 $337718.9900 $1.1200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 448