Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 873 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 9 225.653176 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 225.653176 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 27 27 11.909058 $595.4500 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 1.000000 $51.0500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.511111 $26.0900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.172222 $8.7900 $51.0400
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.066667 $3.4100 $51.0700
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Subtotal (Total Children Is Unduplicated) 31 31 13.659058 $684.7800 $50.1300
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 9 9 6.312047 $315.6000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 116 146 80.790283 $4039.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 3.677777 $91.9400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 253 496 1525.525874 $76276.4600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 19 31.752382 $793.8100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 13 41.290478 $2064.5400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 6.133334 $153.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 9 23.114287 $1155.7200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 12 13 50.347620 $2517.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 10.952381 $273.8100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 24 188.923810 $9446.2000 $50.0000
INTR -T1013 INTERPRETER 11 12 128.142856 $6407.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 0.142857 $1.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 10.000000 $714.4000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 4 35.142857 $2510.6100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 8 58.000000 $4143.5300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 1.714286 $23.7900 $13.8800
TRAV -TRAVS Travel by mile 49 69 547.095234 $243.4600 $0.4400
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Subtotal (Total Children Is Unduplicated) 370 833 2749.058363 $111172.7300 $40.4400
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Total 873 2988.370597 $111857.5100 $37.4300
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Number of Children (Unduplicated) With at Least One Authorization 385