Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1670 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 82 87 57.669046 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 82 87 57.669046 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.422222 $20.4800 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 7 4.097619 $209.1800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 0.483333 $24.6700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.116666 $5.9500 $51.0200
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Subtotal (Total Children Is Unduplicated) 10 12 5.119840 $260.2800 $50.8400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 51 141 101.330155 $5066.5100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.005556 $0.2800 $50.4000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.477778 $11.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 0.261111 $13.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 6.268255 $156.7100 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.644444 $16.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 0.005556 $0.2800 $50.4000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.066666 $26.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 50 56 568.285710 $28414.3300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 3.285714 $164.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1079 1352 11853.552324 $118535.7000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 5 27.192857 $1942.6500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 19.714286 $1408.3900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 3.000000 $214.3200 $71.4400
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Subtotal (Total Children Is Unduplicated) 1126 1571 12585.090412 $155971.2200 $12.3900
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Total 1670 12647.879298 $156231.5000 $12.3500
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Number of Children (Unduplicated) With at Least One Authorization 1193