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 3148 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
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Subtotal (Total Children Is Unduplicated) 8 8 5.705555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 2.000000 $154.2600 $77.1300
OCTF -97168 OT RE-EVAL EST PLAN CARE 10 14 8.850793 $451.8300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 40 41 19.356346 $988.1300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 14 19 6.177777 $315.3700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 0.511111 $26.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 30 32 15.584127 $795.5700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 43 47 47.442060 $2421.9100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 27 27 12.327777 $629.3300 $51.0500
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Subtotal (Total Children Is Unduplicated) 112 184 112.249991 $5782.5000 $51.5100
EI Services, Class # 03
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 4 4 17.142856 $428.5800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 23 29 210.142857 $10507.1700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 818 1848 9120.873002 $91208.7500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 18 136.571430 $9756.6500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 18 21 213.571427 $15257.5600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 10 99.857142 $5707.8400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 10 13 85.357142 $6097.9200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 3.066667 $42.5700 $13.8800
TRAV -TRAVS Travel by mile 40 71 55713.812708 $24792.6500 $0.4500
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Subtotal (Total Children Is Unduplicated) 832 2956 66337.888826 $200674.0800 $3.0300
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Total 3148 66455.844372 $206456.5800 $3.1100
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Number of Children (Unduplicated) With at Least One Authorization 862