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
Eligibility Filter: Program Patients
With the filters selected there were 5770 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 37 40 62.117462 $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) 38 41 63.717462 $59.2000 $0.9300
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 71 97 131.361058 $6568.0600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 11 13 9.849314 $738.7100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 36 36 29.152134 $2186.3900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 6.006850 $450.5100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 2.121919 $159.1400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 18 18 5.590110 $419.2300 $74.9900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 81 82 72.083856 $4000.5900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 92 92 0.831527 $62.2200 $74.8300
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 0.023289 $1.7300 $74.3900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 113 113 0.445230 $33.2800 $74.7400
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 114 114 1.797482 $99.6200 $55.4200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 50 51 0.152068 $11.2700 $74.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 22 23 13.467426 $687.5100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 153 154 106.444601 $5434.0300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 6.000000 $306.3000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 6.177777 $315.3700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 111 116 93.978459 $4797.6400 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 13.406023 $684.3800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 15 15 11.786987 $601.7300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 266 272 159.281735 $8131.4200 $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 28 28 57.316937 $2805.1000 $48.9400
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Subtotal (Total Children Is Unduplicated) 715 1274 733.785893 $38825.5700 $52.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 51 54 49.972604 $249863.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 44 48 90.825868 $4541.3000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 692 865 1233.885704 $61694.3500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 9 18.492858 $462.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 273 332 555.755228 $27787.7500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 6.400000 $160.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 286 357 533.317309 $26665.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 4.400000 $110.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 572 739 990.633293 $49531.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 14 14 26.866668 $671.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 38 54 389.723804 $9743.1100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 695 861 6729.580926 $336479.4600 $50.0000
INTR -T1013 INTERPRETER 18 25 221.047618 $11052.3900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 182 226 1815.127442 $129672.8300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 13 14 120.623810 $6899.6900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 208 257 1988.588092 $142064.7900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 22 25 185.720634 $10615.8100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 414 516 3946.616873 $281946.5200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 51 53 500.642856 $6948.9400 $13.8800
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Subtotal (Total Children Is Unduplicated) 948 4455 19408.221587 $1356912.0300 $69.9100
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Total 5770 20205.724942 $1395796.7900 $69.0800
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Number of Children (Unduplicated) With at Least One Authorization 1056