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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 720 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 21 23 29.969842 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 23 29.969842 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 6 5.374603 $268.7300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 9 9 74.085715 $3704.2800 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 8 11 96.666667 $5617.3100 $58.1100
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Subtotal (Total Children Is Unduplicated) 22 26 176.126985 $9590.3200 $54.4500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 77 123 156.285713 $7814.3000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 17 18 17.500000 $437.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 108 115 106.972222 $5348.6100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 58 62 67.044444 $3352.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 25 23.200000 $1160.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 53 55 51.066666 $2553.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.072222 $26.8100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 152 183 1403.409534 $75784.0400 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 21 199.928571 $16258.2000 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 22.571429 $1469.8500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 20 26 249.038096 $20251.7900 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 30 37 294.739683 $23968.2300 $81.3200
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Subtotal (Total Children Is Unduplicated) 320 671 2594.828580 $158474.8800 $61.0700
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Total 720 2800.925407 $168065.2000 $60.0000
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Number of Children (Unduplicated) With at Least One Authorization 345