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: 07-01-21 and 09-30-21 Date of Report: 10-13-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 397 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 5 5 5.355557 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 5.355557 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 9 9.000000 $436.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 8 9 9.000000 $436.5000 $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 6 9 8.250000 $412.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 6 4.783333 $239.1700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 12.027778 $601.3900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 12 13 41.956352 $2097.8100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 27 28 43.077774 $2153.8700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 53 62 81.569840 $4078.4800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 7 9.233334 $230.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 8 11.755554 $587.7700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 25 28 64.366663 $3218.3200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 19 20 27.799997 $1389.9900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 35 38 50.965870 $2548.2800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.500000 $87.5000 $25.0000
INTR -T1013 INTERPRETER 1 1 6.142857 $307.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 108 145 685.421426 $6854.2100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 6.133333 $438.1600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 9.200000 $657.2500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $938.9300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 3.066667 $219.0900 $71.4400
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Subtotal (Total Children Is Unduplicated) 216 383 1084.393635 $27135.6700 $25.0200
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Total 397 1098.749192 $27572.1700 $25.0900
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Number of Children (Unduplicated) With at Least One Authorization 221