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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1683 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 59 64 102.136508 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 59 64 102.136508 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
EXIT -EXIT COS Exit 1 1 2.000000 $100.0000 $50.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 2 2 2.044444 $290.7800 $142.2300
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Subtotal (Total Children Is Unduplicated) 3 4 5.044444 $506.5900 $100.4200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 114 125 90.598357 $4529.9400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 38 44 54.415080 $2720.7600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 88 92 46.312326 $1157.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 25 28 56.100000 $2805.0000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 8 13.071429 $653.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 8 9.588888 $239.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 13 25.683334 $1284.1700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 6 10.504762 $525.2400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 6.272222 $156.8100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 21.700000 $1085.0000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 1.533333 $76.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 4 9.795238 $244.8800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 8.816667 $440.8400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 4 3.150000 $78.7500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 29.142858 $728.5700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 16.571428 $828.5800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 44.428571 $2221.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 37 47 400.285717 $20014.2900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 3.142857 $157.1500 $50.0000
INTR -T1013 INTERPRETER 46 65 387.492857 $19374.6400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 797 1127 8863.342866 $106360.2000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 6.142857 $442.0400 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 7.000000 $503.7200 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.428571 $255.0900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 3 4 14.097619 $1014.4600 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 1.714286 $123.3500 $71.9600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 9.857143 $567.3700 $57.5600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 31.214286 $2246.1800 $71.9600
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Subtotal (Total Children Is Unduplicated) 844 1615 10177.403552 $171065.8100 $16.8100
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Total 1683 10284.584504 $171572.4000 $16.6800
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Number of Children (Unduplicated) With at Least One Authorization 890