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 1750 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 1 1 0.211111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.211111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.285714 $15.8600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.285714 $21.4300 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.600000 $30.6300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 25 26 10.983332 $560.6900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.411111 $20.9900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 17 19 8.477776 $432.7800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 24 25 10.100000 $515.6100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.511111 $26.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.511111 $25.0100 $48.9400
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Subtotal (Total Children Is Unduplicated) 46 78 33.165869 $1699.0900 $51.2300
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 2 2 18.857142 $471.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 33 35 274.879367 $13743.9700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 737 980 6788.442850 $67884.5000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 67.428572 $4817.1000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 6 8 71.428571 $5102.8600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 18.428572 $1053.3700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 6 32.357144 $2311.5900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 7.857143 $109.0600 $13.8800
TRAV -TRAVS Travel by mile 25 37 29646.174604 $13192.5500 $0.4500
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Subtotal (Total Children Is Unduplicated) 745 1671 37294.422985 $127058.9300 $3.4100
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Total 1750 37327.799965 $128758.0200 $3.4500
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Number of Children (Unduplicated) With at Least One Authorization 769