Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 5045 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 8 8 5.705555 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 2.566668 $94.9700 $37.0000
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Subtotal (Total Children Is Unduplicated) 12 12 8.272223 $94.9700 $11.4800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.255556 $12.4000 $48.5100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 2.511111 $193.6800 $77.1300
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 1.000000 $75.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 9 9 14.857143 $824.5700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 13.857143 $1039.2800 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 33 40 17.478572 $892.2900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 117 134 54.584124 $2786.5100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 48 62 88.315870 $4508.5200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 0.511111 $26.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 96 108 99.930953 $5101.4800 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.066667 $3.4100 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 141 155 123.595231 $6309.5100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 64 72 29.444444 $1503.1400 $51.0500
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Subtotal (Total Children Is Unduplicated) 345 596 446.407925 $23275.8700 $52.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 2.000000 $10000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.833333 $41.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 171 202 165.042844 $8252.0800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 49 47.139681 $2356.9800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 570 689 524.477737 $26223.6900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 112 123 1025.571430 $25639.3100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 780 954 7826.640509 $391332.3700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 818 1848 9120.873002 $91208.7500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 145 172 947.785725 $67709.7500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 10.490476 $600.0600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 111 135 861.692867 $61559.3000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 15 17 185.499999 $10603.1900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 149 169 888.676995 $63487.0400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 28.209524 $391.5500 $13.8800
TRAV -TRAVS Travel by mile 40 71 55713.812708 $24792.6500 $0.4500
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Subtotal (Total Children Is Unduplicated) 947 4437 77348.746830 $784198.3800 $10.1400
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Total 5045 77803.426978 $807569.2200 $10.3800
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Number of Children (Unduplicated) With at Least One Authorization 978