Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 05
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 1651 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 22 24 48.715875 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 24 48.715875 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 2 2.000000 $97.0000 $48.5000
EXIT -EXIT EXIT ASSESSMENT 6 7 10.200000 $510.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 10 16.241096 $901.3800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 3.013698 $167.2600 $55.5000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.388889 $19.8500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 3 0.342467 $17.4800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 0.087672 $4.4700 $51.0100
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Subtotal (Total Children Is Unduplicated) 26 35 38.273822 $2167.4500 $56.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 2.417580 $12087.5000 $4999.8300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 23 93.313415 $4665.6600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 13 14 11.321102 $566.0600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 404 503 756.047209 $37802.3000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 34 43 48.884922 $2444.2500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.466667 $36.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 136 164 196.661906 $9833.1100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 13 15 16.177777 $808.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 15.847619 $396.1900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 190 225 330.736497 $16536.7600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 16 19 20.577776 $1028.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.016667 $0.4200 $25.0500
CONSF -CONSF CONSULT, SLP, FACE TO FACE 317 389 480.121824 $24006.0900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 27 29 35.586508 $1779.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 10.138888 $253.4700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 35 46 256.714286 $12835.7100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 18 20 138.571427 $6928.5900 $50.0000
INTR -T1013 INTERPRETER 5 7 42.285714 $2114.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 1.466667 $14.6700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 5 18.142857 $1296.1100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.857143 $204.1100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 10.142857 $724.6100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 4 20.790476 $1485.2700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 44.857143 $3204.6000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 26.000000 $1857.4400 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 54 62 298.363092 $11039.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 486 1592 2879.508019 $153950.3600 $53.4600
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Total 1651 2966.497716 $156117.8100 $52.6300
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Number of Children (Unduplicated) With at Least One Authorization 506