Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3503 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 7 7 7.899999 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 7 7.899999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 47 64 20.975263 $1017.3400 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 4 4 2.339725 $116.9900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 78 80 42.349162 $2117.4800 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 2.016437 $151.2400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 8.016437 $444.9200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 0.837443 $42.7500 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 3 0.011036 $0.5600 $50.8800
PSTH -97001 EVAL BY LICENSED PT, INITIAL 3 3 0.200000 $10.2100 $51.0500
SCREEN-T1023 SCREENING 7 9 2.857306 $142.8700 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.504110 $76.7900 $51.0500
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Subtotal (Total Children Is Unduplicated) 139 182 84.106919 $4326.6400 $51.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 2.452360 $12263.0000 $5000.4900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 66 27.826146 $1391.3000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 13 18.484721 $462.1200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 346 493 1081.426169 $54071.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 12 17 36.990476 $924.7600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 68 92 189.366672 $9468.3600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 8.800000 $220.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 64 146.185396 $7309.3100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 6.944445 $173.6100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 258 302 669.076227 $33453.9900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 8 20.900002 $522.5100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 44.285714 $1107.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 20 25 188.923808 $9446.2000 $50.0000
INTR -T1013 INTERPRETER 15 21 115.742205 $5787.1100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 463 900 5045.526622 $50455.3200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 13 144.785714 $10343.4900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 16 22 227.028571 $16218.9300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 35 346.394909 $24746.4700 $71.4400
TRAV -TRAVS Travel by mile 523 1226 303883.303997 $135228.0700 $0.4500
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Subtotal (Total Children Is Unduplicated) 540 3314 312204.444154 $373593.2400 $1.2000
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Total 3503 312296.451072 $377919.8800 $1.2100
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Number of Children (Unduplicated) With at Least One Authorization 556