Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 2930 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 39 44 107.679367 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 39 44 107.679367 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 18.714286 $935.7200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 12.423810 $621.1900 $50.0000
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Subtotal (Total Children Is Unduplicated) 5 5 31.138096 $1556.9100 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 2 1.022222 $51.1100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.142857 $225.0600 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 185 230 198.475249 $9923.7500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 69 70 56.587901 $1414.7000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 82 93 99.361742 $4968.0900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.466667 $11.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 56 60 75.370248 $3768.5400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.066667 $101.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 72 87 117.756094 $5887.8300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.066667 $76.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 80 89 97.502351 $4875.1300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.022222 $75.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1130 1472 11428.080948 $571404.7800 $50.0000
INTR -T1013 INTERPRETER 3 5 54.571429 $2728.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 105 145 1138.942860 $81366.1700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 17.714286 $1013.2600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 174 241 1807.858737 $129153.5000 $71.4400
SENS -V5264 EARMOLD 1 2 1.022222 $18.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 294 373 2953.171438 $210974.7800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.142857 $182.4200 $13.8800
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Subtotal (Total Children Is Unduplicated) 1411 2881 18075.345664 $1033221.6400 $57.1600
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Total 2930 18214.163127 $1034778.5400 $56.8100
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Number of Children (Unduplicated) With at Least One Authorization 1442