Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 5761 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
CASE -CASE NON-TCM CASE MANAGEMENT 3 3 4.533333 $167.7300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 104 122 245.974599 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 106 125 250.507932 $167.7300 $0.6700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 41 51 80.128962 $3886.2500 $48.5000
EXIT -EXIT EXIT ASSESSMENT 26 26 52.000000 $2600.0000 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 8 16.000000 $1200.0000 $75.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.000000 $52.5700 $52.5700
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 76 100 177.128962 $9643.8200 $54.4500
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 236 263 313.222831 $15661.1400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 10 16 1.557535 $77.8700 $49.9900
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 35 36 38.829290 $970.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 211 275 597.088889 $29854.4500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 26 30 63.577777 $3178.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 5 13.000000 $325.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 79 93 174.989677 $8749.4600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 7 7 15.977778 $798.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 18.519047 $462.9800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 93 119 267.292855 $13364.6400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 11 13 22.666666 $1133.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 11.199999 $280.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 138 178 382.614287 $19130.7300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 17 21 32.477778 $1623.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 17.366667 $434.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 2.752380 $137.6300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 17 292.719050 $14635.9500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 6.999999 $350.0000 $50.0000
INTR -T1013 INTERPRETER 107 125 550.207142 $27510.3600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1327 2150 15346.396613 $153463.8300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 22.428572 $1602.2900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 3 39.038096 $2788.8800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 3 17.428571 $1245.1000 $71.4400
TRAV -TRAVS Travel by mile 1333 2155 15312.772803 $6814.1700 $0.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1383 5536 33563.124302 $304874.3300 $9.0800
-------------------------------------------------------------------------------------------------------------------------------------
Total 5761 33990.761196 $314685.8800 $9.2600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1442