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: 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 5148 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 12 12 6.777777 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 12 12 6.777777 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 19 15.904110 $771.3500 $48.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 1.022222 $52.1800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 220 271 123.216664 $6290.1900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.516666 $26.3700 $51.0400
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.266667 $13.6200 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 202 255 105.667458 $5394.3200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 121 152 46.899995 $2394.2200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 3 3 0.966667 $49.3500 $51.0500
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Subtotal (Total Children Is Unduplicated) 431 705 294.460449 $14991.6100 $50.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 3.066667 $15333.5000 $5000.0500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 44 128 31.088892 $1554.4600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 26 26 28.522220 $1426.1000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 22 16.566665 $828.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 9.522221 $476.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 14 14 12.649998 $632.4900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 141 207 1415.142858 $35378.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1182 1556 14745.645184 $737282.9000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1133 1572 14585.150740 $145851.6300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 270 349 2428.694454 $173506.0100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 6.428571 $367.7200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 235 307 2201.292061 $157260.4900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 16.857144 $963.5500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 178 234 1345.042867 $96089.8800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 21.857143 $303.3800 $13.8800
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Subtotal (Total Children Is Unduplicated) 1458 4431 36867.527685 $1367255.1400 $37.0900
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Total 5148 37168.765911 $1382246.7500 $37.1900
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Number of Children (Unduplicated) With at Least One Authorization 1467