Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1819 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 128 134 121.607928 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 128 134 121.607928 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 39 50 34.777471 $1686.7000 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 2.525875 $128.9500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 7 3.794445 $193.7100 $51.0500
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Subtotal (Total Children Is Unduplicated) 51 63 42.608902 $2063.2800 $48.4200
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 406 563 920.857924 $46042.8400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 183 243 320.004759 $16000.2200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 173 241 387.251591 $19362.6000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 376 513 710.133318 $35506.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 31 42 259.298412 $12964.9300 $50.0000
INTR -T1013 INTERPRETER 2 2 5.314286 $265.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 6.428571 $459.2600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 7 21.269843 $1519.5300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 10 81.142858 $5796.8400 $71.4400
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Subtotal (Total Children Is Unduplicated) 507 1622 2711.701562 $137918.5000 $50.8600
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Total 1819 2875.918392 $139981.7900 $48.6700
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Number of Children (Unduplicated) With at Least One Authorization 624