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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2995 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 64 72 131.042065 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 64 72 131.042065 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 4.433333 $221.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 7 13.319048 $665.9600 $50.0000
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Subtotal (Total Children Is Unduplicated) 8 9 17.752381 $887.6200 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.022222 $51.1100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 202 251 306.022158 $15301.1300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 101 104 92.446459 $2311.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 69 76 81.192717 $4059.6400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 58 63 114.082401 $5704.1300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 1.400000 $35.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 60 67 88.985716 $4449.3000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 1.600000 $40.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 66 71 76.481746 $3824.0900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.600000 $115.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1162 1507 11243.694444 $562185.3700 $50.0000
INTR -T1013 INTERPRETER 2 2 16.142857 $807.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 117 150 1133.806346 $80999.2500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 161 212 1748.587305 $124919.2100 $71.4400
SENS -V5264 EARMOLD 1 1 1.022222 $18.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 312 397 3229.157138 $230691.1800 $71.4400
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Subtotal (Total Children Is Unduplicated) 1430 2914 18140.243731 $1035511.1200 $57.0800
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Total 2995 18289.038177 $1036398.7400 $56.6700
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Number of Children (Unduplicated) With at Least One Authorization 1477