Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 2232 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
TCM -T1017TL TARGETED CASE MANAGEMENT 11 11 9.422220 $348.6100 $37.0000
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Subtotal (Total Children Is Unduplicated) 11 11 9.422220 $348.6100 $37.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 4.055556 $207.0400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 1.505556 $76.8600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 14 14 5.650000 $288.4300 $51.0500
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Subtotal (Total Children Is Unduplicated) 16 30 11.211112 $572.3300 $51.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 6 14 6.066672 $303.3600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 292 364 201.488100 $10074.4300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 74 49.326985 $2466.3500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 491 605 361.629369 $18081.4900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 6.142857 $153.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 26 31 244.285713 $12214.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 847 1091 8231.217441 $82312.1700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 7.499999 $535.8100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 13.000000 $928.7200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 17.642856 $1260.4200 $71.4400
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Subtotal (Total Children Is Unduplicated) 857 2191 9138.299992 $128330.6000 $14.0400
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Total 2232 9158.933324 $129251.5400 $14.1100
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Number of Children (Unduplicated) With at Least One Authorization 871