Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 1090 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 6 7 4.822221 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 7 4.822221 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 3 3 3.000000 $150.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3 3 3.000000 $150.0000 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.800000 $140.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 1.866667 $93.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 316 414 1139.469047 $56973.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 191 257 754.433331 $37721.6600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 94 115 358.000002 $17900.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 227 279 726.404768 $36320.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 4 6.133333 $153.3300 $25.0000
INTR -T1013 INTERPRETER 7 7 55.857142 $2792.8600 $50.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
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Subtotal (Total Children Is Unduplicated) 374 1080 3046.964290 $152550.9100 $50.0700
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Total 1090 3054.786511 $152700.9100 $49.9900
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Number of Children (Unduplicated) With at Least One Authorization 381