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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 5355 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 27 31 33.498412 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 31 33.498412 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 13 4.433333 $215.0200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.9800 $56.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.622222 $31.7600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 228 279 129.480148 $6609.9200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 211 284 154.282530 $7876.0900 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.355556 $18.1500 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 103 132 49.094439 $2506.2400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 10 12 4.400000 $215.3400 $48.9400
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Subtotal (Total Children Is Unduplicated) 450 725 344.668228 $17585.5000 $51.0200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 57 197 50.961100 $2548.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 14 13.466668 $673.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 3 6.671429 $333.5700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 15 14.205556 $710.2800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 0.850000 $42.5000 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 197 290 2234.285704 $55857.2300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1170 1546 14318.285695 $715914.8000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1173 1638 15249.600782 $152496.1200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 218 251 1988.942063 $142090.2100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 95 104 558.214290 $31929.8800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 199 237 1954.214279 $139609.2400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 85 90 522.428579 $29862.0200 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 97 112 705.867064 $50427.2200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 92 100 509.571434 $7072.8500 $13.8800
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Subtotal (Total Children Is Unduplicated) 1452 4599 38127.564643 $1329567.2400 $34.8700
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Total 5355 38505.731283 $1347152.7400 $34.9900
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Number of Children (Unduplicated) With at Least One Authorization 1473