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: 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 4121 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 4 4 32.385714 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 1.088889 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 15 16 56.930158 $2106.4100 $37.0000
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Subtotal (Total Children Is Unduplicated) 21 22 90.404761 $2106.4100 $23.3000
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.222222 $11.3400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 70 78 59.947614 $3060.3000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.316667 $16.1700 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 30 32 16.749205 $855.0400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 66 74 42.980948 $2194.1600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.166667 $8.1600 $48.9500
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Subtotal (Total Children Is Unduplicated) 97 189 120.383323 $6145.1600 $51.0500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 10 3.761111 $188.0600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 262 311 189.217436 $9460.7600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 47 35.882537 $1794.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 533 639 360.942027 $18046.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 1.511111 $37.7800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 118 140 1077.153961 $26928.8800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 969 1203 9932.015788 $496601.5100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 976 1218 10003.965788 $100039.8100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 114 132 604.342866 $43174.2500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 10.642858 $608.7700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 56 64 348.142863 $24871.3100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 9.428571 $538.9400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 113 131 574.642869 $41052.4600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 36.785714 $510.5900 $13.8800
TRAV -TRAVS Travel by mile 4 4 74.857143 $33.3100 $0.4500
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Subtotal (Total Children Is Unduplicated) 1064 3910 23263.292643 $763887.4400 $32.8400
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Total 4121 23474.080727 $772139.0100 $32.8900
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Number of Children (Unduplicated) With at Least One Authorization 1078