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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 413 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 52 56 115.247626 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 52 56 115.247626 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 4 20.000000 $1000.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 6 10.442858 $522.1500 $50.0000
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Subtotal (Total Children Is Unduplicated) 7 10 30.442858 $1522.1500 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 2 2.000000 $10000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.100000 $5.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 68 93 109.864705 $5493.2400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 23 23 13.963777 $349.0900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 41 46 50.716666 $2535.8300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 36 39 61.980158 $3099.0100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 39 53.588095 $2679.4000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 3.000000 $75.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 47 48 83.801588 $4190.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.000000 $75.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 25 29 212.571428 $10628.5900 $50.0000
INTR -T1013 INTERPRETER 1 1 1.000000 $50.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 27.109524 $1936.7100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 3 14.714286 $1051.1900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 13 103.142857 $7368.5400 $71.4400
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Subtotal (Total Children Is Unduplicated) 178 347 740.553084 $49536.6700 $66.8900
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Total 413 886.243568 $51058.8200 $57.6100
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Number of Children (Unduplicated) With at Least One Authorization 233