Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 3295 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 2 2 0.822222 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 5 6 4.744444 $175.5400 $37.0000
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Subtotal (Total Children Is Unduplicated) 7 8 5.566666 $175.5400 $31.5300
Screening, Eval, and Assessment, Class # 02
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 9 9 15.285714 $848.3600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 15.285714 $1146.4300 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 6 6 2.016667 $102.9500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.227778 $11.6300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 86 98 46.101587 $2353.4900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 13 13 4.283334 $218.6700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 63 71 49.155555 $2509.3900 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.138889 $7.0900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.511111 $26.0900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 91 96 51.154765 $2611.4700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.955555 $48.7800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 2.494444 $122.0800 $48.9400
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Subtotal (Total Children Is Unduplicated) 166 314 189.611113 $10084.2500 $53.1800
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 13.576190 $678.8100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 140 162 97.138878 $4856.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 23 16.469048 $823.4600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 349 399 239.152364 $11957.5400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 2.232540 $55.8100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 122 141 1163.999998 $29100.0500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 724 839 6621.493649 $331075.0700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 737 980 6788.442850 $67884.5000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 110 128 644.142873 $46017.4500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 19 21 97.642861 $5585.1500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 67 76 459.857149 $32852.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 15 16 101.071432 $5777.2200 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 116 121 606.428586 $43323.1700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 7 23.857144 $1364.6300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 17 17 90.357145 $1254.1500 $13.8800
TRAV -TRAVS Travel by mile 25 37 29646.174604 $13192.5500 $0.4500
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Subtotal (Total Children Is Unduplicated) 865 2973 46612.037311 $595798.6100 $12.7800
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Total 3295 46807.215090 $606058.4100 $12.9500
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Number of Children (Unduplicated) With at Least One Authorization 871