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 3697 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 2 2 0.738889 $35.8400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 3 1.877778 $105.3400 $56.1000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 3 0.944445 $48.5600 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 2 2 1.111111 $57.1200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 5 2.672222 $137.3800 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 3 4 2.661112 $136.8100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 1.433334 $73.6900 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 0.916667 $47.1300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 4 1.983333 $101.9600 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 6 6 2.433334 $125.1000 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 4 27.599206 $1418.8800 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 4 6 3.888890 $199.9300 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.761111 $39.1300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.005556 $51.7000 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 1.127778 $57.9800 $51.4100
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Subtotal (Total Children Is Unduplicated) 20 47 51.154766 $2636.5500 $51.5400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
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 32 38 86.974600 $4348.7100 $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 14 16 18.542855 $927.1400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 0.355555 $8.8900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 6.285714 $157.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 4 51.428572 $1285.7100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 62.285714 $3114.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 28 41 777.857142 $38892.8500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 39 51 913.000003 $45649.9900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1780 2888 45388.919820 $544667.0800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 5 47.285715 $3402.6700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 20.285714 $1168.4600 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 1 2 28.000000 $2014.8800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 3 7 143.285715 $10310.8300 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 6 7 45.928571 $3305.0300 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 35.000000 $2518.6000 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 4 6 83.499999 $6008.6700 $71.9600
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Subtotal (Total Children Is Unduplicated) 1849 3405 47963.336494 $679810.4700 $14.1700
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Total 3697 48381.107133 $682447.0200 $14.1100
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Number of Children (Unduplicated) With at Least One Authorization 1959