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: 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 4268 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.411111 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 36 39 42.147620 $1559.4700 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 37 40 42.558731 $1559.4700 $36.6400
Screening, Eval, and Assessment, Class # 02
OCTH -97167 OT EVAL HIGH COMPLEXITY 94 105 64.557947 $3295.7400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 34 39 24.305562 $1240.8300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.433333 $22.1200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 76 88 34.350805 $1753.6700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.011112 $45.0500 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 120 235 124.658759 $6357.4100 $51.0000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 22 7.383331 $369.1600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 304 349 228.196819 $11409.8100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 66 45.611107 $2280.5400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 552 670 410.678573 $20533.9400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.011111 $25.2800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 103 130 1091.982538 $27299.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 950 1189 9844.841253 $492242.0900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 30.571429 $1528.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 966 1216 10041.125379 $100411.2600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 109 137 646.142859 $46160.4600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.714286 $326.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 50 65 330.214287 $23590.5100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 109 140 654.500002 $46757.4900 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1050 3993 23337.972974 $772935.5100 $33.1200
-------------------------------------------------------------------------------------------------------------------------------------
Total 4268 23505.190464 $780852.3800 $33.2200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1064