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 458 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 37 41 103.590478 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 37 41 103.590478 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 18.714286 $935.7200 $50.0000
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Subtotal (Total Children Is Unduplicated) 3 3 18.714286 $935.7200 $50.0000
EI Services, Class # 03
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 72 96 59.487484 $2974.3500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 17 18 14.538377 $363.4600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 39 42 58.212384 $2910.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.466667 $11.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 35 37 57.447557 $2872.3900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.066667 $101.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 50 89.041330 $4452.0900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.066667 $76.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 53 58 78.784240 $3939.2300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 2.022222 $50.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 22 23 177.480951 $8874.0700 $50.0000
INTR -T1013 INTERPRETER 1 1 5.714286 $285.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 14 124.714285 $8909.6100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 27 31 217.280951 $15522.5800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 35 279.285716 $19952.1900 $71.4400
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Subtotal (Total Children Is Unduplicated) 227 414 1175.774863 $71573.0300 $60.8700
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Total 458 1298.079627 $72508.7400 $55.8600
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Number of Children (Unduplicated) With at Least One Authorization 263