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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 4514 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 2.321004 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 2.321004 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 59 78 63.230975 $3066.7000 $48.5000
EXIT -EXIT EXIT ASSESSMENT 97 97 94.785344 $4739.2700 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 16.000000 $888.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 7.000000 $357.3500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.272222 $13.9000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.295890 $15.1100 $51.0500
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Subtotal (Total Children Is Unduplicated) 164 198 197.595389 $10233.1400 $51.7900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 6 5.134247 $25671.0000 $4999.9500
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.227397 $11.3700 $49.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 75 88 151.645702 $7582.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 6 4.061109 $101.5200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 462 607 1416.224835 $70811.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.066667 $26.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 235 298 687.104737 $34355.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.066667 $151.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 55 112.999997 $5649.9900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.666667 $41.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 426 523 1086.995181 $54349.4800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 7 9.266668 $231.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 25 27 186.261904 $9313.0900 $50.0000
INTR -T1013 INTERPRETER 24 36 144.309653 $7215.4900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 522 1083 5929.652585 $59296.4800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 21.571428 $1541.0600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 4 24.071428 $1719.6600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 13.000000 $743.0800 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 29.428571 $2102.3800 $71.4400
TRAV -TRAVS Travel by mile 561 1556 396008.214699 $176223.6600 $0.4500
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Subtotal (Total Children Is Unduplicated) 596 4312 405838.970142 $457138.2900 $1.1300
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Total 4514 406038.886535 $467371.4300 $1.1500
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Number of Children (Unduplicated) With at Least One Authorization 604