Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 1737 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 83 96 137.414286 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 83 96 137.414286 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 24 24 48.000000 $2400.0000 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 24 24 48.000000 $2400.0000 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 82 88 22.480449 $1124.1300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 1.011112 $50.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 70 72 23.816995 $595.4400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 11 18.833334 $941.6700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 1.533333 $76.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 10 17.066667 $426.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 9 15.383333 $769.1700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 4.200000 $210.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 7.366667 $184.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 7.566668 $378.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 11.300000 $565.0000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 1.533333 $76.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 7.800000 $195.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 12 81.571429 $4078.5800 $50.0000
INTR -T1013 INTERPRETER 24 27 345.928568 $17296.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 965 1345 10581.696005 $105817.1100 $10.0000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 0.642857 $36.7700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 5 5 45.999999 $3286.2400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 1.214286 $86.7500 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 3.000000 $195.0000 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 23.928572 $1709.4600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 7.428571 $530.7000 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 977 1617 11231.302178 $138630.5000 $12.3400
-------------------------------------------------------------------------------------------------------------------------------------
Total 1737 11416.716464 $141030.5000 $12.3500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1050