Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 2359 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 47 52 43.000001 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 47 52 43.000001 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 12 16 3.230590 $161.5400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 12 12 10.186302 $509.3100 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 8 8 12.010958 $900.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 8.005479 $600.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 14.010958 $1050.8300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 2.005479 $111.3100 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 14 16 3.677777 $187.7500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 11 3.383334 $172.7200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 8 2.077777 $106.0700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.233333 $11.9100 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 1.716667 $87.6400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 17 21 4.961110 $253.2600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 6 6 2.450000 $125.0700 $51.0500
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Subtotal (Total Children Is Unduplicated) 86 120 68.121986 $4287.4200 $62.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 3.756165 $18781.0000 $5000.0500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 21 8.681203 $434.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 6.077776 $151.9400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 228 316 262.425386 $13121.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 216 280 388.665085 $9716.6400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 170 387 250.911089 $12545.4500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 85 176 210.838890 $5270.9800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 77 177 105.583326 $5279.1300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 46 104 127.250000 $3181.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 182 228 196.356346 $9817.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 186 231 331.314290 $8282.8700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 3 22.428572 $560.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 18 25 140.428571 $7021.4400 $50.0000
INTR -T1013 INTERPRETER 1 2 1.022222 $51.1100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 47 58 445.714284 $31841.8600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 27 39 296.642859 $16967.9800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 22 27 183.316666 $13096.1500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 16 22 158.500000 $9059.8700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 63 78 586.785714 $41919.9800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.428571 $33.7100 $13.8800
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Subtotal (Total Children Is Unduplicated) 472 2187 3729.127015 $207135.1600 $55.5500
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Total 2359 3840.249002 $211422.5800 $55.0500
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Number of Children (Unduplicated) With at Least One Authorization 531