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
Eligibility Filter: Program Patients
With the filters selected there were 5436 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 29 29 42.582540 $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) 30 30 48.715873 $226.9300 $4.6600
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 106 144 183.350295 $9167.5200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 8 3.608220 $270.6200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 11 5.287673 $396.5700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 1.002740 $75.2100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 2.486303 $186.4700 $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 49 51 47.888655 $2657.7800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 78 78 0.282208 $21.0500 $74.5700
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 0.034247 $2.5600 $74.6800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 107 107 0.458933 $34.2800 $74.6800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 101 101 1.715091 $95.0500 $55.4200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 31 0.106860 $7.9600 $74.4700
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 18 18 17.567896 $896.8400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 144 149 91.148620 $4653.1600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 3.922222 $200.2300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 104 109 54.544750 $2784.5600 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 17.304500 $883.4000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 13 13 10.391781 $530.5000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 229 231 140.190093 $7156.8100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 9 9 9.000000 $459.4500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 23 23 46.635618 $2282.3500 $48.9400
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Subtotal (Total Children Is Unduplicated) 666 1127 645.984240 $33320.8600 $51.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 48 53 45.783715 $228919.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 34 36 27.858744 $1392.9200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.234703 $30.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 646 838 1214.713093 $60735.7900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 10 30.636510 $765.9200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 265 325 531.018185 $26550.9200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.533334 $88.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 272 337 452.586042 $22629.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 4 7.933333 $198.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 525 685 916.234167 $45811.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 18 19 37.265081 $931.6300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 48 69 489.514278 $12237.8900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 641 838 6152.979360 $307649.4200 $50.0000
INTR -T1013 INTERPRETER 13 16 196.366666 $9818.3400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 183 223 1573.254745 $112393.4300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 20 21 196.571429 $11243.9000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 190 231 1722.514294 $123056.5200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 16 16 132.368255 $7566.1800 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 420 509 3925.676858 $280450.5700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 40 45 356.964285 $4954.6700 $13.8800
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Subtotal (Total Children Is Unduplicated) 877 4279 18015.007077 $1257425.7200 $69.8000
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Total 5436 18709.707190 $1290973.5100 $69.0000
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Number of Children (Unduplicated) With at Least One Authorization 969