Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 1899 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 13 17 6.011108 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 17 6.011108 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 16 4.921309 $238.6800 $48.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.116667 $5.9600 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 16 18 5.133334 $262.0600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.500000 $25.5300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 3.288889 $167.9000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 8 2.094445 $106.9200 $51.0500
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Subtotal (Total Children Is Unduplicated) 41 53 16.054644 $807.0400 $50.2700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 51 131 41.983338 $2099.1900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 26 31 20.000001 $1000.0100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 16 21 9.861112 $493.0600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 11 11.555556 $577.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 9 3.177778 $158.8900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 68 81 700.714287 $35035.7000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1091 1505 13961.034978 $139610.2100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 22 164.642857 $11762.0600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 7 8 74.428572 $5317.1600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 10 78.142858 $5582.5100 $71.4400
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Subtotal (Total Children Is Unduplicated) 1152 1829 15065.541337 $201636.5600 $13.3800
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Total 1899 15087.607089 $202443.6000 $13.4200
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Number of Children (Unduplicated) With at Least One Authorization 1164