Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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 1217 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 9 9 22.547619 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 22.547619 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 5 5 4.038356 $201.9200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 50 57 31.108352 $1555.4400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 1.500000 $112.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 1.500000 $112.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 0.008220 $0.4600 $55.3800
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.133333 $160.0000 $75.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 3 3 2.252055 $114.9700 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.216438 $11.0500 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.224658 $11.4700 $51.0600
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Subtotal (Total Children Is Unduplicated) 65 72 42.981412 $2280.3000 $53.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 39 61 47.526981 $2376.3300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 340 449 684.936417 $34246.8500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 6 7.550794 $188.7700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 75 92 127.837150 $6391.8500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 135 173 272.358109 $13617.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 217 267 372.255104 $18612.8000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 4.366667 $109.1700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 2 0.066666 $1.6700 $24.9800
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 21 27 176.858733 $8842.9400 $50.0000
INTR -T1013 INTERPRETER 12 19 152.785715 $7639.2800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 6.214286 $443.9500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 6 28.714286 $2051.3500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 6.571429 $469.4600 $71.4400
TRAV -TRAVS Travel by mile 27 30 8166.242860 $3633.9800 $0.4500
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Subtotal (Total Children Is Unduplicated) 380 1136 10054.285197 $98626.2700 $9.8100
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Total 1217 10119.814228 $100906.5700 $9.9700
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Number of Children (Unduplicated) With at Least One Authorization 396