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: 10-01-19 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 3397 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 26 28 46.839684 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.600000 $59.2000 $37.0000
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Subtotal (Total Children Is Unduplicated) 27 29 48.439684 $59.2000 $1.2200
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 36 51 67.118201 $3355.9100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 6 7.005479 $525.4100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 21 21 21.043838 $1578.2600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.002740 $150.2000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 0.015069 $1.1300 $74.6600
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 16 16 5.584630 $418.8200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 45 45 33.881893 $1880.4100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 39 39 0.112338 $8.3200 $74.0400
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 0.008220 $0.6100 $73.9100
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 66 66 0.253437 $18.9300 $74.6900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 57 57 0.495905 $27.4100 $55.2800
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 26 27 0.073980 $5.4700 $73.9100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 13 14 8.505859 $434.2200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 100 101 66.857765 $3413.1100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 6.000000 $306.3000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 4.811111 $245.6100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 82 86 68.821435 $3513.3700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 11.406023 $582.2800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 9 9 7.502055 $382.9800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 175 179 101.271536 $5169.9900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 4 5 3.511111 $179.2400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 20 20 50.927896 $2492.4200 $48.9400
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Subtotal (Total Children Is Unduplicated) 436 768 468.210521 $24741.4400 $52.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 25 23.452055 $117260.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 25 28 65.072973 $3253.6500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 430 534 764.054115 $38202.7500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 15.737302 $393.4400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 157 186 269.350861 $13467.5300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 6.000000 $150.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 191 235 360.931005 $18046.5600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 4.400000 $110.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 339 422 578.196276 $28909.8600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 17.266667 $431.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 20 27 231.285711 $5782.1600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 439 537 4153.347603 $207667.6300 $50.0000
INTR -T1013 INTERPRETER 16 22 194.119047 $9705.9600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 96 114 926.180152 $66166.3600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 8 9 74.909524 $4284.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 124 148 1095.619047 $78271.0500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 15 18 124.214285 $7100.1000 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 202 246 1804.559732 $128917.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 26 27 248.357143 $3447.2000 $13.8800
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Subtotal (Total Children Is Unduplicated) 574 2600 10957.053498 $731569.0800 $66.7700
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Total 3397 11473.703703 $756369.7200 $65.9200
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Number of Children (Unduplicated) With at Least One Authorization 634