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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 6530 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.811111 $30.0100 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 7 7 4.970579 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.166667 $6.1700 $37.0100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 9 9 5.948357 $36.1800 $6.0800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 64 78 50.298098 $2439.4800 $48.5000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EXIT -EXIT EXIT ASSESSMENT 98 98 99.349314 $4967.4700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 96 96 169.552052 $12716.4200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 39 39 59.049311 $4428.7100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 144 145 256.249699 $14221.8700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 45 45 87.505479 $6562.9100 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 7 7 2.570166 $131.2000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 0.633333 $32.3300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 13 3.402741 $173.7200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 34 37 19.158753 $978.0600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 14 15 4.235312 $216.2100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 0.811111 $41.4100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 10 5.079452 $259.3100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 40 45 22.429301 $1145.0300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 2.077778 $106.0700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.400000 $20.4200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 47 51 54.900945 $2802.7100 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 371 700 852.999517 $52226.2400 $61.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 81 99 78.681149 $393408.0000 $5000.0300
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.504110 $25.2100 $50.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 81 90 123.038738 $6151.9300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 3.600000 $90.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 523 660 1536.636132 $76832.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 13.000000 $325.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 254 319 660.090506 $33004.6600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 7.833333 $195.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 52 99.600002 $4980.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 461 548 1106.590534 $55329.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 8 20.266668 $506.6700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.285714 $240.9100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 12 12 1305.714287 $32642.8500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 556 681 5536.971414 $276848.9500 $50.0000
INTR -T1013 INTERPRETER 27 50 131.130235 $6556.5200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 577 1183 6384.168527 $63841.8000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 85 106 906.750002 $64778.2600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 3 19.714286 $1127.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 92 108 932.110717 $66590.0200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 6 31.919765 $1824.5400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 78 87 742.453032 $53040.8800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 9.714286 $134.8300 $13.8800
TRAV -TRAVS Travel by mile 649 1792 438649.725663 $195199.1300 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 682 5821 458303.499100 $1333675.5100 $2.9100
-------------------------------------------------------------------------------------------------------------------------------------
Total 6530 459162.446974 $1385937.9300 $3.0200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 692