Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 521 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 29 31 88.155556 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 31 88.155556 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 6.000000 $300.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 11.704762 $585.2400 $50.0000
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Subtotal (Total Children Is Unduplicated) 5 5 17.704762 $885.2400 $50.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 57 93 144.250000 $7212.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 17 23 24.000000 $600.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 80 88 118.463960 $5923.2100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 0.447185 $11.1800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 60 60 70.084921 $3504.2500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 34 44.533008 $2226.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.450000 $11.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 55 58 100.201587 $5010.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 50 61 481.014284 $24050.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 19 137.923809 $9925.0000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 14 16 144.714285 $10413.6500 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 24 27 219.857141 $15820.9200 $71.9600
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Subtotal (Total Children Is Unduplicated) 241 485 1487.940180 $84759.4100 $56.9600
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Total 521 1593.800498 $85644.6400 $53.7400
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Number of Children (Unduplicated) With at Least One Authorization 274