Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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 4960 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 1 1 0.811111 $30.0100 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 7 7 4.970579 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 5.781690 $30.0100 $5.1900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 59 73 46.092619 $2235.5100 $48.5000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EXIT -EXIT EXIT ASSESSMENT 98 98 99.349314 $4967.4700 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 9.000000 $675.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 2.005479 $150.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 9 9 15.005479 $832.8100 $55.5000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 0.805479 $41.1200 $51.0500
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Subtotal (Total Children Is Unduplicated) 165 194 176.544084 $9113.5700 $51.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.261111 $6305.5000 $4999.9600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.504110 $25.2100 $50.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 81 90 123.038738 $6151.9300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 3.600000 $90.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 522 659 1533.569465 $76678.7200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 13.000000 $325.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 254 319 660.090506 $33004.6600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 7.833333 $195.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 52 99.600002 $4980.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 461 548 1106.590534 $55329.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 8 20.266668 $506.6700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.285714 $240.9100 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 20 26 197.285713 $9864.3000 $50.0000
INTR -T1013 INTERPRETER 27 50 131.130235 $6556.5200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 577 1183 6384.168527 $63841.8000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 17.071428 $1219.5900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 4 20.071429 $1433.9000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 6.714286 $383.7900 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 7 52.810176 $3772.7600 $71.4400
TRAV -TRAVS Travel by mile 649 1791 437861.154234 $194848.2200 $0.4500
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Subtotal (Total Children Is Unduplicated) 671 4758 448243.046209 $465755.1100 $1.0400
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Total 4960 448425.371983 $474898.7000 $1.0600
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Number of Children (Unduplicated) With at Least One Authorization 684