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: 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 4091 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
TCM -T1017TL TARGETED CASE MANAGEMENT 176 181 129.273010 $4783.0800 $37.0000
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Subtotal (Total Children Is Unduplicated) 176 181 129.273010 $4783.0800 $37.0000
Screening, Eval, and Assessment, Class # 02
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.428571 $32.1500 $75.0100
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 4 1.588890 $81.1200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 75 91 56.502391 $2884.5000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 0.850000 $43.3900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 30 35 13.005559 $663.9500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.038889 $1.9900 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 56 68 23.561119 $1202.8400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 8 3.488890 $155.4400 $44.5500
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Subtotal (Total Children Is Unduplicated) 99 211 99.464309 $5065.3600 $50.9300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 6 14 6.066672 $303.3600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 292 364 201.488100 $10074.4300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 74 49.326985 $2466.3500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 491 605 361.629369 $18081.4900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 79 128 724.428565 $18110.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 837 1075 8161.871412 $408093.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 847 1091 8231.217441 $82312.1700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 88 137 507.857145 $36281.3500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 3.928571 $224.7200 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 4.714286 $336.7900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 43 62 232.357146 $16599.6100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 3.928571 $224.5600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 87 138 473.714289 $33842.1900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 12.500000 $173.5000 $13.8800
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Subtotal (Total Children Is Unduplicated) 930 3699 18975.028552 $627124.7900 $33.0500
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Total 4091 19203.765871 $636973.2300 $33.1700
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Number of Children (Unduplicated) With at Least One Authorization 956