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: 07-01-22 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 7637 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 12.052381 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 12.052381 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 71 109 74.940642 $3634.6300 $48.5000
EXIT -EXIT EXIT ASSESSMENT 75 76 91.562755 $4578.1300 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 6.005479 $333.3100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $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 2 2 4.000000 $300.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 2 9.700000 $485.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 3 2.905555 $149.3700 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 23.285714 $1197.1200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.016667 $52.2700 $51.4100
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
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Subtotal (Total Children Is Unduplicated) 147 210 232.422291 $11967.4600 $51.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 5 3.765752 $18828.5000 $4999.9300
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 4.398630 $219.9300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 105 128 243.889078 $12194.4600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 9 11 15.016667 $750.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 13.050000 $326.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 548 967 3826.376558 $191318.8800 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 5 5 11.333333 $566.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 284 447 1743.047248 $87152.3600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 6 6 14.466667 $723.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 7 29.433333 $735.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 60 88 379.040479 $18952.0400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 510 812 3065.451160 $153272.5900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 5 6 17.900001 $895.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 11 39.966668 $999.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 14 18 250.790477 $12539.5300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 49.785714 $2489.2900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 1.000000 $50.0000 $50.0000
INTR -T1013 INTERPRETER 52 111 450.604661 $22530.2300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 650 2157 19733.223553 $236798.7100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 5 101.571428 $7309.0900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 4 6 160.571428 $11554.7300 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 5 81.142857 $5839.0400 $71.9600
TRAV -TRAVS Travel by mile 777 2619 1077772.502858 $479608.7700 $0.4500
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Subtotal (Total Children Is Unduplicated) 809 7425 1108010.328550 $1265705.2200 $1.1400
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Total 7637 1108254.803222 $1277672.6900 $1.1500
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Number of Children (Unduplicated) With at Least One Authorization 817