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: 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 5193 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 53 63 40.044443 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 53 63 40.044443 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 7 2.927777 $141.9900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.9800 $56.4900
OCTF -97168 OT RE-EVAL EST PLAN CARE 7 7 2.127779 $108.6300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.650000 $33.1800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 202 246 105.649202 $5393.3800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 8 2.505556 $127.9100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 0.511112 $26.1000 $51.0600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.422222 $21.5500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 170 222 121.012689 $6177.6700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 81 102 57.743646 $2947.7900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.327777 $16.7300 $51.0400
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 16 18 6.288888 $307.7700 $48.9400
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Subtotal (Total Children Is Unduplicated) 366 619 302.166648 $15415.6900 $51.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 53 176 55.950793 $2797.5400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 2.533334 $126.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 3.077778 $153.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 1.555555 $77.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 1.111111 $55.5600 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 193 276 2275.999980 $56900.0800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1205 1575 14054.161009 $702708.9600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1207 1643 14427.354654 $144273.7400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 118 142 1085.330144 $77536.0500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 145 184 1274.680951 $72911.8100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 101 132 1118.653962 $79916.7900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 130 173 1227.149999 $70143.9700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 24 28 184.642856 $13190.9000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 7 84.285714 $4821.1400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 119 161 992.004770 $13769.0200 $13.8800
TRAV -TRAVS Travel by mile 1 1 2.142857 $0.9500 $0.4500
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Subtotal (Total Children Is Unduplicated) 1486 4511 36791.635467 $1244384.8400 $33.8200
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Total 5193 37133.846558 $1259800.5300 $33.9300
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Number of Children (Unduplicated) With at Least One Authorization 1530