Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 1504 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 41 47 28.572217 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 41 47 28.572217 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 2.672222 $129.6000 $48.5000
NURS -T1001 NURSING ASSESSMENT 1 1 1.571429 $78.5700 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 1.427778 $72.8900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 5 1.244445 $63.5300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $26.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.511111 $22.7700 $44.5500
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Subtotal (Total Children Is Unduplicated) 15 18 7.938096 $393.4500 $49.5700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 48 10.944440 $547.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 8 1.938890 $48.4800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 1.000000 $50.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 1.355556 $33.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 13 13 3.605556 $180.2800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 6.285714 $314.2900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 2.966667 $74.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 8.002380 $400.1200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 0.088889 $4.4500 $50.0100
CONPP -CONPP CONSULT, PT, PHONE 3 3 1.716667 $42.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 10 5.470635 $273.5400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 2.438889 $60.9700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 3.142857 $78.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 40 49 494.307933 $24715.4200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 39.428571 $1971.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1015 1266 11360.888030 $113609.0200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 36.714285 $2622.8800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 5 23.428572 $1673.7400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 6.571429 $469.4600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 11.428571 $653.7200 $57.2000
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Subtotal (Total Children Is Unduplicated) 1044 1439 12021.724531 $147824.5100 $12.3000
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Total 1504 12058.234844 $148217.9700 $12.2900
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Number of Children (Unduplicated) With at Least One Authorization 1078