Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 2131 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 16 17 17.244446 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 17 17.244446 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.000000 $100.0000 $50.0000
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 4 6 6.000000 $302.8200 $50.4700
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 6.166667 $308.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 6 36.433333 $1821.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 466 874 4697.183340 $234859.2000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 4 21.000000 $1050.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 5.466667 $136.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 281 474 2869.157145 $143457.8700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 128 262 1652.766670 $82638.3500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 275 446 2323.166666 $116158.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 20 99.314286 $2482.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 6 89.676190 $4483.8100 $50.0000
INTR -T1013 INTERPRETER 5 6 67.380953 $3369.0500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 3.882143 $279.3600 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 24.857143 $1431.7700 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 1 1 6.964286 $501.1500 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 20.361904 $1465.2400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 10.866667 $781.9700 $71.9600
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Subtotal (Total Children Is Unduplicated) 538 2108 11934.644060 $595225.6000 $49.8700
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Total 2131 11957.888506 $595528.4200 $49.8000
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Number of Children (Unduplicated) With at Least One Authorization 551