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: 07-01-19 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 1187 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 5 5 3.522222 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5 5 3.522222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 7 7 7.000000 $350.0000 $50.0000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 11 11 11.000000 $551.0500 $50.1000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.022222 $5111.0000 $4999.8900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 6 10.766667 $538.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 10 11 18.883333 $944.1700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 3.066667 $76.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 279 412 1239.316665 $61965.8300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 206 308 893.266676 $44663.3800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 107 139 443.500005 $22175.0300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 201 253 737.400003 $36870.0200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11 16 116.714286 $5835.7300 $50.0000
INTR -T1013 INTERPRETER 12 16 152.947622 $7647.3800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 31.952381 $2282.6800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 5 32.923810 $2352.0800 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 353 1171 3694.903194 $191401.2000 $51.8000
-------------------------------------------------------------------------------------------------------------------------------------
Total 1187 3709.425416 $191952.2500 $51.7500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 362