Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1974 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 70 77 155.851588 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 70 77 155.851588 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 36 36 72.000000 $3600.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 36 36 72.000000 $3600.0000 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 5.111111 $255.5600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 121 130 36.911038 $1845.6900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 8 8 2.207541 $55.1900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 28 34 35.748413 $1787.4300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 11 11.866666 $296.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 13 19.500000 $975.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 2.450000 $61.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 11 18.133333 $906.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.483333 $37.0800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 22 28 31.025397 $1551.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 7 8.033333 $200.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 38 48 347.133333 $17356.7000 $50.0000
INTR -T1013 INTERPRETER 25 28 215.361903 $10768.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1023 1453 11316.095243 $113161.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 17 104.392857 $7457.8300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 18 22 112.214287 $8016.5700 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.024658 $1.6100 $65.1100
SENS -V5264 EARMOLD 2 2 2.044444 $36.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 35 40 216.142859 $15441.2400 $71.4400
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Subtotal (Total Children Is Unduplicated) 1034 1861 12485.879749 $180212.5400 $14.4300
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Total 1974 12713.731337 $183812.5400 $14.4600
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Number of Children (Unduplicated) With at Least One Authorization 1092