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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3206 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 21 21 36.493652 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 6.133333 $226.9300 $37.0000
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Subtotal (Total Children Is Unduplicated) 22 22 42.626985 $226.9300 $5.3200
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 60 80 87.352513 $4367.6300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 5 3.293151 $246.9800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 4.009590 $300.7100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 1.001370 $75.1100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 2.012330 $150.9200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 4.057535 $304.3100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 31 32 38.770843 $2151.7600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 28 28 0.078090 $5.7800 $73.9500
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 0.016439 $1.2200 $74.3700
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 56 56 0.205494 $15.3300 $74.6000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 35 35 1.379460 $76.5000 $55.4600
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 0.031510 $2.3400 $74.2600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 12 14.305567 $730.3000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 91 94 55.654251 $2841.1700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.411111 $123.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 71 75 35.826941 $1829.0000 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 14.304500 $730.2500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 5.049315 $257.7700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 143 144 84.258954 $4301.4700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 6 6 6.000000 $306.3000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 16 16 41.306850 $2021.5600 $48.9400
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Subtotal (Total Children Is Unduplicated) 381 635 405.325814 $21043.7000 $51.9200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 21 23 18.800001 $94000.5000 $5000.0300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 23 17.807754 $890.3800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.233333 $30.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 407 530 770.103051 $38505.2100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 23.647620 $591.1900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 150 183 240.055884 $12002.8100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.533334 $88.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 183 227 288.989276 $14449.4900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 4 7.933333 $198.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 300 389 514.110465 $25705.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 13 24.755556 $618.8900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 25 38 253.999996 $6350.0100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 408 537 3811.209523 $190560.7400 $50.0000
INTR -T1013 INTERPRETER 11 14 163.509523 $8175.4900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 96 115 782.362701 $55892.0500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 12 12 126.357143 $7227.6400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 108 137 941.947622 $67292.8200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 12 12 109.428572 $6254.9500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 211 257 1831.260186 $130825.3300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 22 25 225.428570 $3128.9600 $13.8800
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Subtotal (Total Children Is Unduplicated) 529 2549 10156.473443 $662789.4800 $65.2600
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Total 3206 10604.426242 $684060.1100 $64.5100
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Number of Children (Unduplicated) With at Least One Authorization 574