Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 467 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 17 18 15.238888 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 18 15.238888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 14 11.338888 $549.9300 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.405556 $9.5300 $23.5000
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Subtotal (Total Children Is Unduplicated) 10 15 11.744444 $559.4600 $47.6400
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.433333 $329.6600 $229.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 8 6.250000 $312.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 9 11 12.116667 $605.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 8.166667 $408.3400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 8 8 5.884921 $294.2500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 24 33.355555 $1667.7800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 47 51 68.280955 $3414.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 6.461112 $161.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 26 61.886507 $3094.3300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 21 24 47.778572 $2388.9400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 16 17 15.900001 $795.0100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 21 23 41.818254 $2090.9100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.500000 $62.5000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 6.714285 $335.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1 1 1.366667 $68.3400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 3 18.406349 $920.3200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 161 217 969.664284 $9696.6400 $10.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 12.857143 $918.5100 $71.4400
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Subtotal (Total Children Is Unduplicated) 254 434 1321.841272 $27590.1300 $20.8700
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Total 467 1348.824604 $28149.6000 $20.8700
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Number of Children (Unduplicated) With at Least One Authorization 269