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: 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 1270 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 3 3 2.388889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 2.388889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 4 4 4.000000 $200.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 3 3 3.000000 $150.0000 $50.0000
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 9 9 9.000000 $445.6000 $49.5100
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 4 5.366666 $268.3300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 13 15 24.883333 $1244.1700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.750000 $18.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 318 491 1438.800000 $71940.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 203 287 903.500000 $45175.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 102 132 429.866659 $21493.3000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 225 284 791.258327 $39562.8900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11 14 85.309525 $4265.4800 $50.0000
INTR -T1013 INTERPRETER 16 20 237.614287 $11880.7100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 19.285714 $1377.7700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 3 13.780953 $984.5100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 5 31.142858 $2224.8400 $71.4400
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Subtotal (Total Children Is Unduplicated) 382 1258 3981.558322 $200435.7400 $50.3400
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Total 1270 3992.947211 $200881.3400 $50.3100
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Number of Children (Unduplicated) With at Least One Authorization 385