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: 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 2328 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 7 7 28.400000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 0.922222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 29.322222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.227778 $11.6300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 10 11.644445 $594.4500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.177778 $9.0800 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 4 1.261111 $64.3800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 12 12 12.388889 $632.4500 $51.0500
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Subtotal (Total Children Is Unduplicated) 15 28 25.700001 $1311.9900 $51.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 5 1.044446 $52.2300 $50.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 230 264 178.885696 $8944.2000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 26 30 23.393647 $1169.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 492 605 393.111870 $19655.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 4.905555 $122.6400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 12 53.557936 $1338.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 55 66 568.999999 $28450.0500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 992 1269 10498.019022 $104980.3200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 6 28.285714 $2020.7300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 3.428571 $196.1200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 3 3 22.142857 $1581.8900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.500000 $200.0600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 8 22.785714 $1627.8200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 5.857143 $81.3000 $13.8800
TRAV -TRAVS Travel by mile 13 13 10912.714284 $4856.1600 $0.4500
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Subtotal (Total Children Is Unduplicated) 1005 2291 22720.632454 $175277.5400 $7.7100
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Total 2328 22775.654677 $176589.5300 $7.7500
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Number of Children (Unduplicated) With at Least One Authorization 1010