Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3951 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 2 2 2.577778 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.059525 $2.2000 $36.9800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3 3 2.637303 $2.2000 $0.8300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 2.422223 $117.4800 $48.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 26 26 8.311111 $424.2800 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 84 99 50.967162 $2601.9200 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 35 40 12.083334 $616.8600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 89 98 130.933169 $6684.2000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 2 0.505555 $25.8100 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 70 75 49.269054 $2515.2100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 12 12 3.581746 $182.8500 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 231 358 258.073354 $13168.6100 $51.0300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.002740 $13.5000 $4927.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 38 95 54.021437 $2701.1100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 13 20 13.161113 $658.0700 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 13.000000 $325.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 128 197 1276.571426 $31914.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1048 1360 10357.045765 $517852.3900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1008 1343 10587.469032 $105874.7100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 151 190 1239.007143 $88514.7000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 10 76.714286 $4388.0500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 137 178 1242.648410 $88774.8000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 14 15 105.214286 $6014.0500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 126 171 965.980953 $69009.7000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 13.571429 $776.2800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 5 6 35.533333 $493.2000 $13.8800
TRAV -TRAVS Travel by mile 1 1 3.857143 $1.7200 $0.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1262 3590 25983.798496 $917311.5600 $35.3000
-------------------------------------------------------------------------------------------------------------------------------------
Total 3951 26244.509153 $930482.3700 $35.4500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1263