Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-18 and 12-31-18 Date of Report: 02-05-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 6462 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 116 127 281.182537 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 116 127 281.182537 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 38 44 27.745815 $1345.6800 $48.5000
EXIT -EXIT EXIT ASSESSMENT 157 161 319.500000 $15975.0000 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 8.500000 $471.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 7.500000 $562.5000 $75.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 200 217 368.245815 $18705.9800 $50.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 12.290944 $61455.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.855556 $42.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 17 18 11.722223 $586.1200 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.044444 $10.2100 $229.7700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 184 198 198.411411 $9920.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 7 12.300000 $307.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 160 212 487.905201 $24395.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.600000 $40.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 36 46 101.143656 $5057.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.533333 $63.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 89 108 221.089688 $11054.5100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 126 152 306.829786 $15341.5800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 5.666667 $141.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 71 75 617.942855 $30897.1800 $50.0000
INTR -T1013 INTERPRETER 132 150 598.858578 $29942.9700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1479 2432 17017.692584 $170177.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 7 39.857144 $2847.3900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 7 7 44.985713 $3213.7800 $71.4400
RSPT -RSPT RESPITE 1 1 3.571429 $0.0000 $0.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 32 268.399999 $19174.5100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 7.571429 $105.0900 $13.8800
TRAV -TRAVS Travel by mile 1531 2655 17423.809247 $7753.6100 $0.4500
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Subtotal (Total Children Is Unduplicated) 1555 6118 37385.081887 $392527.4300 $10.5000
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Total 6462 38034.510239 $411233.4100 $10.8100
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Number of Children (Unduplicated) With at Least One Authorization 1627