Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 51
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 889 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 10 10 21.679364 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 2 3.033334 $112.2400 $37.0000
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Subtotal (Total Children Is Unduplicated) 11 12 24.712698 $112.2400 $4.5400
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 13 13 13.857143 $692.8600 $50.0000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.733333 $55.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 5.061111 $258.3700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 30 31 34.142857 $1743.0000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 11 33.714286 $1721.1100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 8.285714 $369.1300 $44.5500
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Subtotal (Total Children Is Unduplicated) 74 78 105.794444 $5349.9500 $50.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.933333 $96.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 13.255554 $662.7700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 6 6.877778 $171.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 4 2.966667 $148.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 6.628571 $331.4300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 7 6.455554 $322.7700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.011111 $100.2800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 193 242 2429.833331 $121491.6700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 144 187 1796.745237 $128359.4800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.285714 $163.2900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 13.285714 $759.9500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 0.857143 $49.0300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 45 58 528.998810 $37791.6600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 211 264 2676.511904 $191210.0400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 18.857143 $1078.6300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 6 7 60.428571 $838.7500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 0.428571 $15.8600 $37.0000
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Subtotal (Total Children Is Unduplicated) 448 799 7571.360706 $488592.5300 $64.5300
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Total 889 7701.867848 $494054.7200 $64.1500
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Number of Children (Unduplicated) With at Least One Authorization 466