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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 912 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 90 97 60.278835 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 90 97 60.278835 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 30 42 32.563851 $1579.3500 $48.5000
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 32 44 34.563851 $1681.4500 $48.6500
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 96 101 97.866671 $4893.3600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 1.822222 $91.1100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 133 168 273.170626 $13658.4900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 6.711110 $335.5500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 102 138 211.808731 $10590.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 243 296 374.154755 $18707.7100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 7 9 7.733332 $386.6600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 37 49 308.401587 $15420.0800 $50.0000
INTR -T1013 INTERPRETER 1 1 9.100000 $455.0000 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 3 3 3.809523 $272.1500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 12.133334 $866.8100 $71.4400
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Subtotal (Total Children Is Unduplicated) 406 771 1306.711891 $65677.3500 $50.2600
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Total 912 1401.554577 $67358.8000 $48.0600
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Number of Children (Unduplicated) With at Least One Authorization 499