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: 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 4212 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 71 80 51.344442 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 71 80 51.344442 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 9 11 4.311113 $209.1000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.283333 $14.4600 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.955556 $48.7800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 148 189 69.577799 $3552.0600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.311111 $15.8800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.061111 $3.1200 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.261111 $13.3300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 120 158 62.261127 $3178.5100 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 1.511112 $77.1500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.172222 $8.7900 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 62 89 26.108736 $1332.8800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.255556 $13.0500 $51.0600
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 9 2.938891 $130.9400 $44.5500
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Subtotal (Total Children Is Unduplicated) 269 468 170.008778 $8654.5300 $50.9100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 29 89 24.930560 $1246.5500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 7 3.322223 $166.1200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 8 5.344445 $267.2300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 1.944444 $97.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 114 217 1261.857144 $31546.4100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 981 1283 11025.795244 $551289.7700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 21 21 288.999999 $14450.0100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 998 1323 11297.599215 $112976.0100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 120 152 1131.926987 $80864.8500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 79 128 706.499998 $40411.8100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 110 152 1099.071424 $78517.6800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 13.000000 $928.7200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 57 86 501.321429 $28655.5300 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 34 43 313.928572 $22427.0500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 27 41 229.642860 $13135.5600 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 13.000000 $928.7200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 54 95 441.928568 $6133.9800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 10 14 50.178571 $1856.6200 $37.0000
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Subtotal (Total Children Is Unduplicated) 1207 3664 28411.291683 $985924.8100 $34.7000
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Total 4212 28632.644903 $994579.3400 $34.7400
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Number of Children (Unduplicated) With at Least One Authorization 1252