Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 7342 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
CASE -CASE NON-TCM CASE MANAGEMENT 3 3 2.844444 $105.2400 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 95 106 437.203969 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 38 44 1379.428577 $51038.8400 $37.0000
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Subtotal (Total Children Is Unduplicated) 135 153 1819.476990 $51144.0900 $28.1100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 42 50 35.578690 $1725.5700 $48.5000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 4.000000 $153.8800 $38.4700
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 155 157 311.750000 $15587.5000 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 13 14 28.000000 $1554.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 19.500000 $1462.5000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 211 241 411.828690 $21385.5500 $51.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 5.000000 $25000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 10 11 10.022222 $501.1100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 3.877778 $891.8900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 237 255 399.374034 $19968.7100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 33.352381 $833.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 187 242 509.739687 $25487.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 3.866666 $96.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 66 75 135.238890 $6761.9500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 109 136 259.065882 $12953.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 92.000000 $2300.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 143 177 325.983336 $16299.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 9.733333 $243.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 54 65 514.161902 $25708.1400 $50.0000
INTR -T1013 INTERPRETER 172 188 849.149993 $42457.5400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1606 2742 18168.234862 $181682.5000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 6.133333 $438.1600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 23.714286 $1694.1500 $71.4400
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 8 51.285714 $3663.8600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 2 13.142857 $182.4200 $13.8800
TRAV -TRAVS Travel by mile 1632 3019 18535.030102 $8248.1000 $0.4500
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Subtotal (Total Children Is Unduplicated) 1663 6948 39949.107258 $375411.8400 $9.4000
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Total 7342 42180.412938 $447941.4700 $10.6200
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Number of Children (Unduplicated) With at Least One Authorization 1707