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: 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 778 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 96 104 65.994436 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 96 104 65.994436 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 25 34 27.904958 $1353.4000 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 1.222222 $62.3900 $51.0500
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Subtotal (Total Children Is Unduplicated) 28 37 29.127180 $1415.7900 $48.6100
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 35 38 63.700001 $3185.0100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 127 156 230.249209 $11512.4700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 1.255556 $62.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 84 101 152.877777 $7643.8900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 0.744444 $37.2200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 205 279 360.387307 $18019.3900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 7 8 7.477777 $373.8900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 35 48 222.977776 $11148.9000 $50.0000
INTR -T1013 INTERPRETER 1 1 55.200000 $2760.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 3 21.509524 $1536.6500 $71.4400
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Subtotal (Total Children Is Unduplicated) 379 637 1116.379371 $56280.1800 $50.4100
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Total 778 1211.500987 $57695.9700 $47.6200
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Number of Children (Unduplicated) With at Least One Authorization 474