Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 01-01-21 and 03-31-21 Date of Report: 05-04-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 327 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 15 19 22.866666 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 15 19 22.866666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 3.000000 $145.5000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 4 4 4.000000 $169.2000 $42.3000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 9 6.005556 $300.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 10 11 7.142857 $357.1500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 3.583333 $179.1700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 14 14 25.172224 $1258.6200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.933333 $48.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 25 26 44.167460 $2208.3800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 57 66 102.634126 $5131.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 8 20.983333 $524.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 7.905556 $395.2800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 22 25 56.270634 $2813.5300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 12.000000 $300.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 26 26 31.200002 $1560.0100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 26 29 35.727780 $1786.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 9.311111 $232.7800 $25.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 44.338096 $2216.9100 $50.0000
INTR -T1013 INTERPRETER 1 1 0.700000 $35.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 48 59 242.811111 $2428.1100 $10.0000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 7.714286 $551.1100 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 194 304 659.600798 $22327.3200 $33.8500
-------------------------------------------------------------------------------------------------------------------------------------
Total 327 686.467464 $22496.5200 $32.7700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 208