Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 5871 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 89 98 468.556348 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 89 98 468.556348 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 46 62 51.141706 $2480.3800 $48.5000
EXIT -EXIT EXIT ASSESSMENT 142 144 288.000000 $14400.0000 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 1.500000 $83.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 6 7 14.000000 $1050.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 194 224 374.141706 $19320.1300 $51.6400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 3.000000 $150.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 228 269 323.138204 $16156.9000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 6 1.526026 $76.3100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 52 57 66.491260 $1662.2900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 222 284 694.818268 $34740.9900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 8 8 12.750001 $637.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 11 16.333333 $408.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 76 101 235.866668 $11793.3400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 7.200000 $360.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 32.914287 $822.8600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 116 148 338.162710 $16908.1900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 3 3 3.466666 $173.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 8.066667 $201.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 159 202 459.831756 $22991.6400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 3 3 6.800000 $340.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 15.366668 $384.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 22 25 196.709525 $9835.4900 $50.0000
INTR -T1013 INTERPRETER 137 175 872.027004 $43601.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1171 2112 14617.611056 $146176.2600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 5.428571 $387.8200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 58.704762 $4193.8600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 27.571428 $1969.7100 $71.4400
TRAV -TRAVS Travel by mile 1171 2116 14631.668200 $6511.1000 $0.4500
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Subtotal (Total Children Is Unduplicated) 1224 5549 32635.453060 $320483.1300 $9.8200
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Total 5871 33478.151114 $339803.2600 $10.1500
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Number of Children (Unduplicated) With at Least One Authorization 1284