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: 10-01-23 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 574 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 39 42 100.455558 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 39 42 100.455558 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 10 44.666667 $2233.3400 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 5 5 56.142857 $2886.3100 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 12 15 100.809524 $5119.6500 $50.7900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 66 101 145.264058 $7263.2100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 12 14 12.500000 $312.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 103 111 120.459525 $6022.9800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 52 54 68.476191 $3423.8100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 30 39.949207 $1997.4600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 57 61 71.138095 $3556.9000 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 13.142857 $657.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 71 91 671.990482 $33599.5300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 19 152.428573 $10968.7700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 12 13 114.006349 $8203.9100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 22 200.357143 $14417.7200 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 249 517 1609.712480 $90423.9100 $56.1700
-------------------------------------------------------------------------------------------------------------------------------------
Total 574 1810.977562 $95543.5600 $52.7600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 293