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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 4036 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 10 11 9.922222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 11 9.922222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 50 69 12.834165 $622.4600 $48.5000
EXIT -EXIT EXIT ASSESSMENT 90 90 52.034247 $2601.7000 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 0.008220 $0.6200 $74.8200
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 6.004110 $333.2300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.004110 $0.3100 $74.8200
NURS -T1001 NURSING ASSESSMENT 1 1 0.002740 $0.1400 $49.2700
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.158904 $8.1100 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 5 5 1.389041 $70.9100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 3 0.602132 $30.7400 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.317808 $16.2200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 3 0.493150 $25.1800 $51.0600
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.161644 $8.2500 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.353425 $18.0400 $51.0500
SCREEN-T1023 SCREENING 3 3 0.983333 $49.1700 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 8 2.565526 $130.9700 $51.0500
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Subtotal (Total Children Is Unduplicated) 149 197 81.912555 $4216.0400 $51.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 12 2.514154 $12570.0000 $4999.6900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 80 100 30.475563 $1523.7400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 7 8.216666 $205.4200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 370 555 1002.566010 $50128.2800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 10 21.228571 $530.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 91 127 221.050001 $11052.5100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 9.266667 $231.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 84 155.025566 $7751.2600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 8.394444 $209.8600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 277 359 624.931744 $31246.5800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 9.400001 $235.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 25 27 204.214286 $10210.7000 $50.0000
INTR -T1013 INTERPRETER 22 29 148.761693 $7438.0700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 492 982 4758.964070 $47589.5800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 22 187.928573 $13425.6000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 18 21 196.142857 $14012.4300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 31 43 330.323877 $23598.3000 $71.4400
TRAV -TRAVS Travel by mile 557 1436 297047.882083 $132186.3100 $0.4500
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Subtotal (Total Children Is Unduplicated) 569 3828 304967.286826 $364146.0100 $1.1900
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Total 4036 305059.121603 $368362.0400 $1.2100
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Number of Children (Unduplicated) With at Least One Authorization 581