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 1601 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
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Subtotal (Total Children Is Unduplicated) 26 28 46.839684 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 31 45 58.118201 $2905.9100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.084932 $6.3700 $74.9700
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 4.072603 $226.0200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 0.008219 $0.6200 $74.8300
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 0.013699 $0.7600 $55.5100
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.002740 $0.2000 $73.9100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.122222 $6.2400 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 1.079452 $55.1100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.252055 $12.8700 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 0.841096 $42.9400 $51.0600
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Subtotal (Total Children Is Unduplicated) 50 75 72.606177 $3857.8600 $53.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 25 28 65.072973 $3253.6500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 430 533 763.554115 $38177.7500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 7 15.737302 $393.4400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 157 185 268.317528 $13415.8600 $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 3 4 20.428570 $510.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 26 29 229.571426 $11478.6000 $50.0000
INTR -T1013 INTERPRETER 16 20 177.119047 $8855.9600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 16.857143 $1204.2700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 23.142857 $1323.7700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 6 8 42.000001 $3000.4700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6 7 46.571428 $3327.0600 $71.4400
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Subtotal (Total Children Is Unduplicated) 511 1498 2636.166338 $137589.6200 $52.1900
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Total 1601 2755.612199 $141447.4900 $51.3300
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Number of Children (Unduplicated) With at Least One Authorization 536