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: 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 3718 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 14.030158 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 14.030158 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 56 75 62.851065 $3048.2600 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 3 0.366666 $18.3300 $49.9900
EXIT -EXIT EXIT ASSESSMENT 90 90 88.842707 $4442.1400 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.500000 $582.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.500000 $337.5000 $75.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 1.243836 $63.5000 $51.0500
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Subtotal (Total Children Is Unduplicated) 146 180 171.304274 $8693.5300 $50.7500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 5 5.000000 $25000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 68 81 122.370469 $6118.5200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 3.849999 $192.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 16 16 14.220835 $355.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 398 528 1169.023080 $58450.9500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 3.033333 $151.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 219 277 673.023786 $33651.0700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 10.266667 $256.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 42 53 104.499995 $5224.9800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.033333 $75.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 357 455 882.919002 $44145.7300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 15.999998 $400.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 23 30 170.352380 $8517.6300 $50.0000
INTR -T1013 INTERPRETER 17 24 116.549205 $5827.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 439 932 5032.966625 $50329.6500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 4 29.857143 $2132.9900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 4 40.285714 $2878.0100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 6.428571 $367.4600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 4 28.000000 $2000.3200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 6.857143 $95.1800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 415 1098 314086.605355 $139768.5400 $0.4500
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Subtotal (Total Children Is Unduplicated) 474 3534 322526.142633 $385977.6600 $1.2000
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Total 3718 322711.477065 $394671.1800 $1.2200
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Number of Children (Unduplicated) With at Least One Authorization 489