Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1385 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 57 60 82.095237 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 57 60 82.095237 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.600000 $30.8500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 6 8 12.600000 $793.2600 $62.9600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 32 40 41.007934 $2050.3900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 20 21 26.691269 $1334.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 2.000000 $50.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 331 401 616.613891 $30830.7000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 91 107 165.248409 $8262.4100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 129 145 241.021441 $12051.1200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 42 44 63.300000 $3165.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.855556 $21.3900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 99 121 166.997619 $8349.8800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 40 45 61.763491 $3088.1700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.466667 $61.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 226 260 401.438090 $20071.8800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 98 109 176.282537 $8814.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 4.088889 $102.2200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 44.000000 $2200.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 44.142857 $2207.1500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 13.142857 $657.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3 4 27.285714 $272.8600 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 6.571429 $472.8800 $71.9600
TRAV -TRAVS Travel by mile 2 2 58.142857 $25.8700 $0.4500
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Subtotal (Total Children Is Unduplicated) 397 1317 2163.061507 $104089.3800 $48.1200
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Total 1385 2257.756744 $104882.6400 $46.4500
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Number of Children (Unduplicated) With at Least One Authorization 441