Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 1603 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 87 93 79.422227 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 87 93 79.422227 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.672222 $32.6000 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 13.523810 $690.3900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 1.216667 $62.1100 $51.0500
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Subtotal (Total Children Is Unduplicated) 8 8 15.412699 $785.1000 $50.9400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 42 130 116.037307 $5801.8700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 6 2.777777 $138.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.711111 $17.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 4 1.622222 $81.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 9.045237 $226.1300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.511111 $25.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 0.466667 $23.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.577778 $64.4500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 22.000000 $1100.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 29 33 273.571428 $13678.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1049 1310 11090.084930 $110900.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 4.285714 $306.1700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 18.000000 $1285.9200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 9.428571 $538.9400 $57.1600
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Subtotal (Total Children Is Unduplicated) 1092 1502 11551.119853 $134189.4200 $11.6200
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Total 1603 11645.954779 $134974.5300 $11.5900
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Number of Children (Unduplicated) With at Least One Authorization 1157