Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1223 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 113 120 86.111217 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 113 120 86.111217 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 34 47 35.980977 $1745.0900 $48.5000
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 7 5.049999 $257.8000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 0.505555 $25.8100 $51.0400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 38 56 41.536531 $2028.6900 $48.8400
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 232 256 383.868252 $19193.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.633333 $40.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 149 196 282.073802 $14103.6500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 110 151 225.100788 $11255.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 270 367 435.988073 $21799.3000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 44 58 351.546027 $17577.3100 $50.0000
INTR -T1013 INTERPRETER 2 2 9.585714 $479.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 0.214286 $15.3100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 6 8 33.466667 $2390.8600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 7 31.114286 $2222.8100 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 410 1047 1754.591228 $89077.7500 $50.7700
-------------------------------------------------------------------------------------------------------------------------------------
Total 1223 1882.238976 $91106.4500 $48.4000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 524