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: 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 4945 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 59 78 41.011111 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 59 78 41.011111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 11 4.727779 $229.3000 $48.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 5 1.705555 $87.0700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 3 0.516666 $26.3700 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 185 238 97.663518 $4985.8600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 5 1.972223 $100.6900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.505556 $25.8100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.505556 $25.8100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 156 214 86.840499 $4433.3300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 4 1.372221 $70.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.505556 $25.8100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 86 114 54.135725 $2763.6800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.738889 $37.7200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 9 14 3.183334 $141.8200 $44.5500
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Subtotal (Total Children Is Unduplicated) 338 613 254.373077 $12953.3200 $50.9200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 2 2.000000 $10000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 51 182 50.663898 $2533.2400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 3.266667 $163.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 5.444444 $272.2200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.855556 $42.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 3 3.033333 $151.6700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 157 234 1696.428567 $42410.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1093 1461 13044.762695 $652238.1600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 21 21 76.857144 $3842.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1119 1543 13171.477778 $131714.7900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 128 158 1343.362699 $95969.8300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 118 159 1044.959528 $59771.6800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 110 148 1103.908726 $78863.2800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.714286 $336.7900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 94 130 953.364682 $54494.3400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 33 38 341.000000 $24361.0400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 43 49 311.214287 $17801.4600 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 3.000000 $214.3200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 94 114 674.928574 $9368.0000 $13.8800
TRAV -TRAVS Travel by mile 1 1 4.142857 $1.8400 $0.4500
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Subtotal (Total Children Is Unduplicated) 1357 4254 33839.385721 $1184552.3400 $35.0100
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Total 4945 34134.769909 $1197505.6600 $35.0800
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Number of Children (Unduplicated) With at Least One Authorization 1399