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: 07-01-22 and 09-30-22 Date of Report: 10-19-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 983 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 20 20 20.583334 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 20 20 20.583334 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 8 4.894445 $237.3800 $48.5000
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Subtotal (Total Children Is Unduplicated) 7 8 4.894445 $237.3800 $48.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.700000 $3500.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.066667 $247.0700 $231.6300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 4 3.155555 $157.7800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 8.746824 $437.3400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 1.450000 $72.5000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 53 64 75.134922 $3756.7500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 22 23 20.244445 $1012.2300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 9.898413 $247.4600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 48 76.703967 $3835.1900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 7 7 23.564285 $1178.2100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 33 34 45.849996 $2292.4800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 10 10 9.683334 $484.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 3.200000 $80.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 17 20 367.690475 $18384.5400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5 6 38.714286 $1935.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 512 717 4229.888860 $42298.9200 $10.0000
PHY -97110TLGT PT SESSION BY LICENSED PT 1 2 12.928571 $930.3400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 26.285714 $1891.5300 $71.9600
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Subtotal (Total Children Is Unduplicated) 535 955 4955.906314 $82792.2000 $16.7100
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Total 983 4981.384093 $83029.5800 $16.6700
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Number of Children (Unduplicated) With at Least One Authorization 550