Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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 1555 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 14 14 21.804762 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 14 21.804762 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 5.428571 $678.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 5 5 5.073973 $253.7000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 77 89 95.999087 $4799.9600 $50.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 0.004110 $0.3100 $74.8200
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.002740 $0.1500 $54.6700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.004110 $0.3100 $74.8200
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 1.227397 $62.6600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.189041 $9.6500 $51.0700
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.090411 $4.6100 $51.0400
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Subtotal (Total Children Is Unduplicated) 88 105 108.024919 $5810.3400 $53.7900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 16 22.926985 $1146.3500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.022222 $25.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 426 551 1595.683804 $79784.2100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 5 6.647186 $166.1800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 115 137 185.100299 $9255.0400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.033333 $100.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 202 247 402.953259 $20147.7000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 314 400 605.583568 $30279.2400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 3.066667 $76.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 4 11.200000 $280.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 21 24 197.719047 $9885.9800 $50.0000
INTR -T1013 INTERPRETER 18 24 237.099999 $11854.9900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 27.357142 $1954.4000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 4 22.890475 $1635.3000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 10 66.214286 $4730.3400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.142857 $182.4200 $13.8800
TRAV -TRAVS Travel by mile 4 5 103.285714 $45.9600 $0.4500
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Subtotal (Total Children Is Unduplicated) 468 1436 3505.926843 $171551.1600 $48.9300
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Total 1555 3635.756524 $177361.5000 $48.7800
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Number of Children (Unduplicated) With at Least One Authorization 488