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: 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 1733 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 71 76 63.572220 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 71 76 63.572220 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 14 15.599207 $756.5600 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.655556 $47.8800 $28.9200
OCTH -97165 OT EVAL LOW COMPLEXITY 35 45 29.655557 $1524.6000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 28 33 18.883337 $970.8100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 37 52 35.422223 $1821.0600 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 3 5.761904 $296.2200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 68 93 54.012050 $2776.7800 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 161 243 161.989834 $8245.3200 $50.9000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 13 10.002055 $50010.5000 $5000.0200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 29 33 44.911111 $2245.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 141 179 254.522209 $12726.0500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 57 73 100.014279 $5000.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 99 125 170.488882 $8524.4100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 472 716 3631.844446 $181592.2500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 37 49 340.038096 $24469.1600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 63 109 493.523807 $35513.9900 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 74 117 520.747621 $37473.0300 $71.9600
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Subtotal (Total Children Is Unduplicated) 629 1414 5566.092506 $357555.6100 $64.2400
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Total 1733 5791.654560 $365800.9300 $63.1600
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Number of Children (Unduplicated) With at Least One Authorization 696