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: 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 2196 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 2 2 1.066667 $39.4700 $37.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.066667 $39.4700 $37.0000
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 9 3.377778 $172.4400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.466667 $23.8300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 10 4.400000 $224.6200 $51.0500
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Subtotal (Total Children Is Unduplicated) 8 20 8.244445 $420.8800 $51.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 8 0.966668 $48.3400 $50.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 365 444 459.072210 $22953.5300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 70 87 181.292063 $9064.5900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 516 619 501.477745 $25073.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14 17 159.571427 $7978.5800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 806 996 8184.139638 $81841.5100 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 9.142857 $653.1700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 22.285714 $1592.1000 $71.4400
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Subtotal (Total Children Is Unduplicated) 811 2174 9517.948322 $149205.5200 $15.6800
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Total 2196 9527.259434 $149665.8700 $15.7100
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Number of Children (Unduplicated) With at Least One Authorization 817