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: 07-01-20 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 1107 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 29 36 80.727778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 36 80.727778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 11 9.988888 $484.4600 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 12 13 12.988888 $608.1600 $46.8200
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.855556 $142.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 18 23 20.261112 $1013.0600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 34 36 27.999999 $1400.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 10 32.717460 $1635.8800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 20 22 87.475397 $4373.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 20.361904 $509.0500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 77 87 189.328570 $9466.4200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 97 126 319.617456 $15980.8600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 11 12 44.050000 $1101.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 26 28 71.261112 $3563.0600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 40 53 192.826982 $9641.3500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 17.400000 $435.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 59 70 170.631748 $8531.5900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 70 80 164.947617 $8247.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 14 23.277777 $581.9400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 7 27.945237 $1397.2600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 18.685714 $934.2900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 12 14 150.457143 $7522.8600 $50.0000
INTR -T1013 INTERPRETER 1 1 3.733333 $186.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 344 455 2442.801578 $24428.0300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 4.000000 $285.7600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 20.857143 $1490.0300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.000000 $142.8800 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 7.142857 $264.2900 $37.0000
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Subtotal (Total Children Is Unduplicated) 569 1058 4064.635695 $103530.4300 $25.4700
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Total 1107 4158.352361 $104138.5800 $25.0400
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Number of Children (Unduplicated) With at Least One Authorization 587