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: 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 4705 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 4 5 5.243835 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 5 5.243835 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 51 67 32.837728 $1592.6500 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 2 0.511111 $25.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 93 94 95.953274 $4797.6700 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 11.505479 $638.5600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 7.500000 $562.5000 $75.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.305556 $15.6000 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.202740 $10.3500 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 4 2.511111 $128.1900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.516591 $26.3700 $51.0400
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Subtotal (Total Children Is Unduplicated) 148 187 156.849069 $8148.9000 $51.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 10.193738 $50969.0000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 62 66 74.904076 $3745.2100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 1.538851 $38.4700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 502 668 1479.089885 $73954.7900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 9 16.335714 $408.3900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 215 261 501.790499 $25089.6500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 5.583333 $139.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 40 51 93.500005 $4675.0300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.166667 $4.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 387 470 1024.528610 $51226.6300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 9.300001 $232.5000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 17.000000 $1246.4400 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14 15 153.785714 $7689.2900 $50.0000
INTR -T1013 INTERPRETER 23 32 116.252446 $5812.6300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 579 1118 6584.731913 $65847.3900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 11 61.428573 $4388.4400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 12 16 108.814287 $7773.6900 $71.4400
SENS -V5264 EARMOLD 1 1 0.002740 $0.0500 $17.7400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 10 80.142858 $5725.4100 $71.4400
TRAV -TRAVS Travel by mile 643 1766 498933.044415 $222025.2000 $0.4500
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Subtotal (Total Children Is Unduplicated) 653 4513 509272.134325 $530991.9400 $1.0400
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Total 4705 509434.227229 $539140.8400 $1.0600
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Number of Children (Unduplicated) With at Least One Authorization 664