Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 6261 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
CASE -CASE NON-TCM CASE MANAGEMENT 4 4 6.555556 $242.5600 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 93 107 446.627777 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 10 10 184.622222 $6831.0200 $37.0000
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Subtotal (Total Children Is Unduplicated) 105 121 637.805555 $7073.5800 $11.0900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 37 53 44.489652 $2157.7500 $48.5000
EXIT -EXIT EXIT ASSESSMENT 82 82 164.000000 $8200.0000 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 3 6.000000 $450.0000 $75.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 116 140 217.489652 $10969.8000 $50.4400
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 6 5.011111 $250.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 205 236 312.838376 $15641.9200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 135 148 138.461349 $3461.5400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 195 262 608.192055 $30409.5600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 10 17.333333 $433.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 72 95 175.311106 $8765.5300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 5.433334 $135.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 108 142 275.024595 $13751.1900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 11.176190 $279.4100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 150 199 367.007929 $18350.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 14.883334 $372.0900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 50 60 549.309521 $27465.4800 $50.0000
INTR -T1013 INTERPRETER 100 121 764.924605 $38246.2400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1318 2348 16168.091223 $161680.9200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 20.733333 $1481.1900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 13.000000 $928.7200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 6 23.876191 $1705.7000 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 9.000000 $333.0000 $37.0000
TRAV -TRAVS Travel by mile 1317 2346 16221.919796 $7218.7500 $0.4400
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Subtotal (Total Children Is Unduplicated) 1344 6000 35704.527381 $331421.3100 $9.2800
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Total 6261 36559.822588 $349464.6900 $9.5600
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Number of Children (Unduplicated) With at Least One Authorization 1410