Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 07-01-19 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 2920 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 20 20 22.555554 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 16.333333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 3.911111 $144.7100 $37.0000
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Subtotal (Total Children Is Unduplicated) 24 24 42.799998 $144.7100 $3.3800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 11 8.337444 $404.3700 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.072222 $25.4100 $23.7000
EXIT -EXIT EXIT ASSESSMENT 6 6 9.594444 $479.7200 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.561111 $42.0800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.561111 $31.1400 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 20.433332 $1021.6600 $50.0000
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Subtotal (Total Children Is Unduplicated) 22 25 40.559664 $2004.3800 $49.4200
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.088889 $4.4500 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 65 58.424604 $2921.2400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 0.005556 $0.2800 $50.4000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 4.500000 $112.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 59 69 183.305555 $9165.2800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 9.857143 $246.4300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 117 152 331.450794 $16572.5500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 15 15 27.638888 $1381.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 35.048413 $876.2100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 94 119 287.185710 $14359.2600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 7 7 6.022223 $301.1200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.500000 $12.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 78 93 179.345238 $8967.2600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 17 18 18.522223 $926.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 14.666666 $366.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 5 24.877778 $621.9500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 43.740476 $2187.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 30 35 388.128570 $19406.4400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 3.800000 $190.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1033 2250 20286.981215 $202869.8600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 37.171428 $2655.5200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 7 81.971428 $5856.0400 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.857143 $132.6700 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.377778 $24.5600 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 32.523810 $2323.5000 $71.4400
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Subtotal (Total Children Is Unduplicated) 1051 2871 22058.991528 $292531.3300 $13.2600
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Total 2920 22142.351190 $294680.4300 $13.3100
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Number of Children (Unduplicated) With at Least One Authorization 1064