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: 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 4279 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 3 4 1.277777 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 4 1.277777 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 13 7.222224 $350.2900 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.626027 $131.3000 $50.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.142857 $57.1500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 9 12 2.983333 $152.3000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 147 165 107.046821 $5464.7200 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 10 12 4.033333 $205.9000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 144 172 137.830151 $7036.2000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.500000 $25.5300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 86 105 98.136188 $5009.8200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 5 5 0.866666 $44.2400 $51.0500
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Subtotal (Total Children Is Unduplicated) 319 489 362.387600 $18477.4400 $50.9900
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.511111 $36.6000 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 45 143 43.538877 $2176.8900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 11.241900 $562.0900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 3.877777 $193.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 17.811112 $890.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 28.558730 $1427.9400 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 151 216 1663.285706 $41582.2000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1080 1391 11735.220253 $586761.3900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1048 1384 11459.370638 $114593.7700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 184 225 1499.786513 $107144.7300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 16.428572 $939.7200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 172 222 1647.357152 $117687.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 17.428572 $996.2100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 133 169 903.577792 $64551.5500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 11.000000 $629.2000 $57.2000
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Subtotal (Total Children Is Unduplicated) 1326 3786 29059.994705 $1040223.9400 $35.8000
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Total 4279 29423.660082 $1058701.3700 $35.9800
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Number of Children (Unduplicated) With at Least One Authorization 1326