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: 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 1794 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 5 5 2.811111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 2.811111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 14 10.304686 $499.7800 $48.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 2 2 1.000000 $51.0500 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.277778 $14.1800 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 6 6 3.055555 $155.9800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 6 1.333334 $68.0700 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 6 2.538888 $129.6100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.571429 $29.1700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 9.692064 $494.7800 $51.0500
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Subtotal (Total Children Is Unduplicated) 33 40 28.773734 $1442.6200 $50.1400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 44 140 42.827774 $2141.3700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 20 20 10.016667 $500.8400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 20 20 14.816665 $740.8300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 11 12.933334 $646.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 11 12 5.122222 $256.1100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 48 57 556.915874 $27845.7800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1110 1466 12475.340507 $124753.3500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 14 101.642858 $7261.3600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 6 6 74.000000 $5286.5600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 20.571429 $1469.6200 $71.4400
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Subtotal (Total Children Is Unduplicated) 1155 1749 13315.187330 $170952.4800 $12.8400
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Total 1794 13346.772175 $172395.1000 $12.9200
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Number of Children (Unduplicated) With at Least One Authorization 1164