Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 8629 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 200 245 366.615873 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 200 245 366.615873 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 6 23.215079 $1125.9300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 10 7.722222 $433.2200 $56.1000
OCTH -97165 OT EVAL LOW COMPLEXITY 45 51 72.780953 $3741.6800 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.211111 $10.8500 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 18 19 12.888890 $662.6200 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 5 5 2.433333 $125.1000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 52 75 119.224604 $6129.3500 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.722222 $37.1300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 64 93 49.517458 $2545.6800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 20 23 15.366668 $790.0100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 7 8 3.022222 $155.3700 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 2 1.033334 $53.1300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 3 3 2.205556 $113.3900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 39 58 25.627777 $1317.5200 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 45 68 67.849205 $3488.1300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 25 36 43.493652 $2236.0200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 56 90 76.568253 $3936.3800 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 3 2.144444 $110.2400 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 6 7 4.611111 $237.0600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 18 22 12.605558 $648.0600 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 4 1.338889 $68.8300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 15 20 7.833334 $402.7200 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 0.950000 $48.8400 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 7.714286 $396.5900 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 3 46.000000 $2364.8600 $51.4100
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Subtotal (Total Children Is Unduplicated) 250 612 607.080161 $31178.7000 $51.3600
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 2.000000 $138.7000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 65 291 193.179379 $9659.0300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 18 31.821429 $1591.0700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 5 11.011110 $275.2800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 33 39 97.546029 $4877.2800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 8 14.822220 $370.5500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 0.777778 $38.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.788889 $44.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 16 18 22.238093 $1111.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 0.355555 $8.8900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 13 16 147.714285 $3692.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 215 543 5405.499997 $135137.5200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 7 86.142856 $4307.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 847 1233 18556.683342 $927834.1500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1126 1695 27169.484892 $1358474.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1781 2889 45392.205534 $544706.5100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 83 114 1366.285713 $98317.9300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 25.857143 $1860.6800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 36 51 403.736902 $23255.2600 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 135 217 2768.403968 $199214.3800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 54 78 930.000001 $66922.8000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 28 53 318.857143 $18353.4300 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 8.571429 $493.3700 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 81 146 1656.214283 $119181.2200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 21.714286 $1562.5600 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 2 3 3.000000 $54.3900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 66 95 677.209921 $48732.0400 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 108 205 2192.928568 $157803.1600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 3 19.499999 $1403.2300 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 14 28 198.357142 $2769.0700 $13.9600
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Subtotal (Total Children Is Unduplicated) 2032 7772 107729.907886 $3733624.1000 $34.6600
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Total 8629 108703.603920 $3764802.8000 $34.6300
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Number of Children (Unduplicated) With at Least One Authorization 2126