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: 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 1301 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 4.133333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 4.133333 $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 3 3 3.000000 $150.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 8 8 8.000000 $396.6500 $49.5800
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 2.166667 $108.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 4 8.899999 $445.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 23 31.766667 $1588.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 318 492 1337.452388 $66872.6600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 201 277 828.283331 $41414.1600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 106 138 421.357140 $21067.8400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 254 313 828.874986 $41443.6800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13 16 66.504762 $3325.2400 $50.0000
INTR -T1013 INTERPRETER 13 19 174.400000 $8719.9900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 3 19.533333 $1395.4600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 15.616667 $1115.6600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 28.428571 $2030.9400 $71.4400
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Subtotal (Total Children Is Unduplicated) 384 1290 3763.284511 $189527.2800 $50.3600
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Total 1301 3775.417844 $189923.9300 $50.3100
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Number of Children (Unduplicated) With at Least One Authorization 389