Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2001 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 29 34 22.727775 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 34 22.727775 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 47 86 43.550612 $2112.2200 $48.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 8 5.038889 $257.2400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 7 5.100000 $260.3600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 20 26 16.805555 $857.9200 $51.0500
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Subtotal (Total Children Is Unduplicated) 74 128 71.495056 $3538.7800 $49.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 3.444444 $17222.0000 $4999.9400
CONIF -CONIF CONSULT, ITDS FACE TO FACE 392 558 1381.757148 $69087.8600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 204 277 655.544444 $32777.2300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 179 262 549.983336 $27499.1600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 417 568 1160.186534 $58009.4400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 58 74 301.974605 $15098.7500 $50.0000
INTR -T1013 INTERPRETER 29 39 285.869845 $14293.5100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 9 64.561905 $4612.2900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 10 12 73.195239 $5229.0700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 27 35 260.409524 $18603.6700 $71.4400
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Subtotal (Total Children Is Unduplicated) 556 1839 4736.927024 $262432.9600 $55.4000
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Total 2001 4831.149855 $265971.7400 $55.0500
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Number of Children (Unduplicated) With at Least One Authorization 590