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: 04-01-21 and 06-30-21 Date of Report: 07-15-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 406 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 9 9 14.416666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 14.416666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 4 4.000000 $194.0000 $48.5000
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Subtotal (Total Children Is Unduplicated) 3 4 4.000000 $194.0000 $48.5000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 5 4.005556 $200.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 10 10 9.500000 $475.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 9.705556 $485.2800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 14 14 36.627778 $1831.4000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 33 38 52.584921 $2629.2500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 60 68 86.894445 $4344.7300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 8.033333 $200.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 9 13.933333 $696.6700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 25 28 67.839680 $3391.9800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 22 27 35.461111 $1773.0600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 34 38 59.509524 $2975.4800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 9 9.005556 $225.1400 $25.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 21.430953 $1071.5500 $50.0000
INTR -T1013 INTERPRETER 1 1 3.033333 $151.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 95 128 411.182539 $4111.8200 $10.0000
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.000000 $142.8800 $71.4400
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Subtotal (Total Children Is Unduplicated) 234 393 833.747618 $24806.9900 $29.7500
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Total 406 852.164284 $25000.9900 $29.3400
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Number of Children (Unduplicated) With at Least One Authorization 241