Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 2810 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 66 82 173.274609 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 66 82 173.274609 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.066667 $153.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 9 33.004761 $1650.2400 $50.0000
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Subtotal (Total Children Is Unduplicated) 8 10 36.071428 $1803.5700 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 109 172 248.983641 $12449.1900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 110 163 172.608071 $4315.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 145 165 182.588886 $9129.4300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 11 11 9.038889 $225.9700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 101 110 108.551588 $5427.5800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 53 59 79.823016 $3991.1500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 118 129 130.477779 $6523.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 7.566666 $189.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 930 1246 10252.007912 $512601.0300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 39.428571 $1971.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 126 160 1277.642851 $91274.9700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 129 179 1526.690471 $109066.8900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 4 46.857142 $3347.4900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 235 305 2620.190467 $187186.6800 $71.4400
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Subtotal (Total Children Is Unduplicated) 1132 2718 16717.598807 $948688.9900 $56.7500
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Total 2810 16926.944844 $950492.5600 $56.1500
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Number of Children (Unduplicated) With at Least One Authorization 1181