Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 51
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 858 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 12 15 27.977779 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 3.066667 $113.4700 $37.0000
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Subtotal (Total Children Is Unduplicated) 13 16 31.044446 $113.4700 $3.6600
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 5 5 5.000000 $250.0000 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 3.066667 $230.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 6.116667 $312.2600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 32 32 37.000000 $1888.8500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 9.000000 $459.4500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 27.714286 $1414.8200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $146.8200 $48.9400
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Subtotal (Total Children Is Unduplicated) 71 73 96.897620 $5012.9500 $51.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 8.088889 $404.4500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 10 15.455555 $772.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 8 18.288890 $457.2300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 3 3.966667 $198.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 5.366667 $268.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 14.017460 $700.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 17.377779 $434.4500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 201 238 2311.690471 $115584.6400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 126 162 1581.709517 $112997.4300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 7 10 68.857142 $3938.6300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 39 49 480.598810 $34333.9900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 219 259 2554.247606 $182475.6000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.000000 $343.2000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 8 8 94.285713 $1308.6900 $13.8800
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Subtotal (Total Children Is Unduplicated) 448 769 7180.951166 $459218.6200 $63.9500
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Total 858 7308.893232 $464345.0400 $63.5300
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Number of Children (Unduplicated) With at Least One Authorization 469