Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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 1470 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 30 46.323810 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 30 46.323810 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.716667 $35.8400 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 1.246575 $63.6400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.022222 $52.1800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $26.0900 $51.0500
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Subtotal (Total Children Is Unduplicated) 7 10 11.496575 $699.7500 $60.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.511111 $12555.5000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 29 34 37.788889 $1889.4500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 13 16 9.549999 $477.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 370 452 715.388907 $35769.5200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 49 57 98.753177 $4937.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 179 208 358.728583 $17936.4700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 24 25 50.141272 $2507.0700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 141 169 255.178977 $12758.9900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 27 32 46.999999 $2350.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.033333 $25.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 289 342 500.575784 $25028.8800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 58 72 110.911109 $5545.5400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13 13 143.714284 $7185.7300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 12.857143 $642.8600 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 1.533333 $109.5400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 15.142857 $1081.8100 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 6.571429 $243.1400 $37.0000
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Subtotal (Total Children Is Unduplicated) 467 1430 2369.380186 $131145.4600 $55.3500
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Total 1470 2427.200571 $131845.2100 $54.3200
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Number of Children (Unduplicated) With at Least One Authorization 492