Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 1765 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 69 78 104.152376 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 69 78 104.152376 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 4 4 13.123810 $656.1900 $50.0000
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Subtotal (Total Children Is Unduplicated) 4 4 13.123810 $656.1900 $50.0000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.022222 $51.1100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 157 166 92.647279 $4632.4100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 16 16 7.590874 $379.5500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 87 90 53.771658 $1344.2900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 19 23 44.830952 $2241.5500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 0.966667 $48.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 11 13 20.564286 $514.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 12 26.433333 $1321.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 8 12.146429 $303.6600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 10 20.416667 $1020.8400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 5.233333 $130.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 4.566666 $228.3300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.966667 $48.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 6.490477 $162.2600 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 52.571429 $1314.2900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 3.747619 $187.3800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 17 20 144.000001 $7200.0000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 1.285714 $64.2900 $50.0000
INTR -T1013 INTERPRETER 36 40 363.464284 $18173.2100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 894 1251 9581.133317 $95811.4200 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 4 5 54.642857 $3932.1000 $71.9600
SENS -V5264 EARMOLD 1 1 1.022222 $18.5300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 5 52.428571 $3772.7600 $71.9600
TRAV -TRAVS Travel by mile 1 1 6.133333 $2.7300 $0.4400
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Subtotal (Total Children Is Unduplicated) 930 1683 10558.076857 $142903.9500 $13.5400
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Total 1765 10675.353043 $143560.1400 $13.4500
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Number of Children (Unduplicated) With at Least One Authorization 986