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: 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 5357 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 55 67 41.080950 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 55 67 41.080950 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 9 2.722222 $132.0300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.9800 $56.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.194444 $9.9200 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 198 252 106.154754 $5419.1500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 184 261 121.649204 $6210.1900 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.066667 $3.4100 $51.0700
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 60 66 32.003968 $1633.8000 $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 25 27 8.166666 $399.6700 $48.9400
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Subtotal (Total Children Is Unduplicated) 370 621 273.980147 $13973.3300 $51.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 43 118 32.355554 $1617.7700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2 2 1.177778 $58.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.222222 $11.1100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 4 1.633333 $81.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 2 2.433334 $60.8400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 199 329 2182.857134 $54571.5200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1201 1621 14650.082508 $732504.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1195 1725 15306.229348 $153062.4200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 99 105 838.999997 $59938.2400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 156 230 1353.388886 $77413.9100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 105 124 939.794448 $67138.9500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 146 211 1315.857155 $75214.4400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 21 108.928571 $7781.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 108 176 843.642867 $11709.7600 $13.8800
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Subtotal (Total Children Is Unduplicated) 1447 4669 37577.603135 $1241166.1800 $33.0300
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Total 5357 37892.664232 $1255139.5100 $33.1200
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Number of Children (Unduplicated) With at Least One Authorization 1488