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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2980 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 14 14 21.804762 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 14 21.804762 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 5.428571 $678.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 5 5 5.073973 $253.7000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 77 89 95.999087 $4799.9600 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.005480 $0.4100 $73.9100
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 0.012329 $0.9200 $74.8200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 0.057534 $4.3100 $74.8300
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 20 20 6.058908 $454.3900 $74.9900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 28 28 4.089048 $226.9100 $55.4900
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 22 22 2.064389 $154.7800 $74.9700
OCTH -97166 OT EVAL MODERATE COMPLEXITY 20 22 8.991781 $459.0300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 49 52 17.676332 $902.4100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.504110 $25.7400 $51.0600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 9 4.191781 $213.9900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 61 61 20.981053 $1071.1100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.189041 $9.6500 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 115 121 58.569221 $2990.0100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 30 30 12.070397 $616.1900 $51.0500
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Subtotal (Total Children Is Unduplicated) 320 484 245.963035 $13162.0700 $53.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 20 22 19.955523 $99778.0000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 16 22.926985 $1146.3500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.022222 $25.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 426 551 1595.683804 $79784.2100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 5 6.647186 $166.1800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 115 137 185.100299 $9255.0400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.033333 $100.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 202 247 402.953259 $20147.7000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 314 400 605.583568 $30279.2400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 3.066667 $76.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 42 65 375.047625 $9376.1900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 404 518 3845.903182 $192295.4000 $50.0000
INTR -T1013 INTERPRETER 18 24 237.099999 $11854.9900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 80 98 670.711252 $47915.6400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 22.785716 $1303.3400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 122 146 1083.252391 $77387.5900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 35.214286 $2012.8500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 184 225 1672.783336 $119503.7400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.785714 $44.9400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 89.000001 $1235.3200 $13.8800
TRAV -TRAVS Travel by mile 4 5 103.285714 $45.9600 $0.4500
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Subtotal (Total Children Is Unduplicated) 510 2482 10982.842062 $703735.7100 $64.0800
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Total 2980 11250.609859 $716897.7800 $63.7200
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Number of Children (Unduplicated) With at Least One Authorization 546