Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 4018 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 1 1 1.300000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 1.300000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 57 80 36.238614 $1757.5900 $48.5000
EXIT -EXIT EXIT ASSESSMENT 92 93 116.810503 $5840.5200 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 10.000000 $750.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 4 0.852131 $43.5000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.356165 $18.1800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.126027 $6.4300 $51.0400
PSTH -97161 PT EVAL LOW COMPLEXITY 2 3 0.320548 $16.3700 $51.0600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 3 0.279453 $14.2600 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 0.631507 $32.2400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.573973 $29.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 1.136454 $58.0100 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.246575 $12.3300 $50.0100
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Subtotal (Total Children Is Unduplicated) 153 209 181.571950 $9433.7400 $51.9600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 9 4.828768 $24143.5000 $4999.9300
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.493151 $113.4400 $230.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 56 62 57.700882 $2885.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.255556 $31.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 401 574 1188.440838 $59422.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 6.933333 $173.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 145 183 343.283336 $17164.1800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 7.450000 $186.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 45 60 109.333334 $5466.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 300 378 673.200005 $33660.0300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.216666 $80.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 20 135.071427 $6753.5700 $50.0000
INTR -T1013 INTERPRETER 30 49 120.166731 $6008.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 473 933 4663.165616 $46631.6000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 16 140.428573 $10032.2000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 9 11 74.714286 $5337.5800 $71.4400
SENS -V5264 EARMOLD 1 1 0.711111 $12.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 19 22 184.000001 $13144.9500 $71.4400
TRAV -TRAVS Travel by mile 543 1476 359411.931206 $159938.3100 $0.4500
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Subtotal (Total Children Is Unduplicated) 555 3808 367126.324820 $391185.6000 $1.0700
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Total 4018 367309.196770 $400619.3500 $1.0900
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Number of Children (Unduplicated) With at Least One Authorization 563