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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1743 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 96 106 153.377780 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 96 106 153.377780 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT COS Exit 109 111 89.250000 $4462.5000 $50.0000
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Subtotal (Total Children Is Unduplicated) 109 111 89.250000 $4462.5000 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.077778 $5.4000 $69.3700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 96 101 101.426115 $5071.3100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 37 39 32.453350 $1622.6700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 47 48 25.036075 $625.9100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 14 18.655557 $932.7900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 2 2 2.266667 $113.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 10 17.521429 $438.0400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 7 7.622222 $381.1100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 3.155556 $157.7800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 6.483334 $162.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 4 3.833334 $191.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 4 9.166666 $229.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 4 4.333333 $216.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 7.133334 $178.3400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 28.571429 $714.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 68 84 647.685719 $34975.0700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 6 41.923810 $2263.8900 $54.0000
INTR -T1013 INTERPRETER 51 73 612.614283 $30630.7000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 786 1100 8514.142859 $102169.8300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 42.133333 $3426.2800 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.500000 $40.6600 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.428571 $288.3900 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 8.428571 $548.8700 $65.1200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 5 26.285714 $2137.5600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 3 25.571428 $2079.4700 $81.3200
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Subtotal (Total Children Is Unduplicated) 821 1526 10192.450467 $194601.2400 $19.0900
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Total 1743 10435.078247 $199063.7400 $19.0800
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Number of Children (Unduplicated) With at Least One Authorization 908