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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2694 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 5 5 108.103176 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 108.103176 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 43 64 60.607319 $2939.4700 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
EVAL -96111 DEVELOPMENTAL EVALUATION 4 5 2.194445 $109.7300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 49 49 48.777397 $2438.8700 $50.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.500000 $249.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.500000 $187.5000 $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 2 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 99 127 125.579161 $6292.3300 $50.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 6 6.000000 $30000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 49 54 53.458516 $2672.9300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 2.673611 $133.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 5 2.079167 $51.9800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 307 385 827.388494 $41369.6300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 4.533334 $226.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 162 198 408.261921 $20413.1800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 5.166667 $258.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 6 11.433334 $285.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 36 68.666670 $3433.3500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 5.133334 $128.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 275 327 654.347648 $32717.5400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 6 6 14.633335 $731.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 15.366668 $384.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11 15 83.395237 $4169.7700 $50.0000
INTR -T1013 INTERPRETER 15 26 147.116436 $7355.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 345 726 4080.967387 $40809.7700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 3 19.571428 $1398.1800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 3 26.000000 $1857.4300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 5 35.571428 $2541.2200 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 310 742 222593.446563 $99054.0900 $0.4500
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Subtotal (Total Children Is Unduplicated) 376 2562 229066.211178 $290030.5800 $1.2700
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Total 2694 229299.893515 $296322.9100 $1.2900
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Number of Children (Unduplicated) With at Least One Authorization 392