Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 370 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 1.966667 $72.7700 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 54 61 144.596826 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 55 62 146.563493 $72.7700 $0.5000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 45 73 106.574428 $5328.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 19 24 24.266340 $606.6600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 47 50 86.018723 $4300.9500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.155556 $3.8900 $25.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 44 45 60.940150 $3047.0200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 32 35 42.655556 $2132.7800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 47 48 75.946033 $3797.3100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.155556 $53.8900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14 16 132.842855 $6642.1600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 6 27.209523 $1943.8500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 6 47.285714 $3378.1000 $71.4400
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Subtotal (Total Children Is Unduplicated) 152 308 607.050434 $31260.3200 $51.5000
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Total 370 753.613927 $31333.0800 $41.5800
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Number of Children (Unduplicated) With at Least One Authorization 207