Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 5755 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 38 38 41.822221 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 89 100 21967.865079 $812811.0100 $37.0000
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Subtotal (Total Children Is Unduplicated) 117 138 22009.687300 $812811.0100 $36.9300
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.274277 $57.3400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 2.555555 $293.8800 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 35 42 24.068946 $1203.4500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 36 37 53.390411 $2669.5200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 11 20.011111 $1500.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 13 20.027701 $1502.0800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 10.016590 $555.9200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 214 215 418.032874 $31352.4800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 172 173 340.016437 $25501.2400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 73 73 132.038353 $9902.8900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 71 72 136.021916 $7549.2200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 18 36.000000 $2700.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 71 82 28.732533 $1466.7600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 31 35 11.799999 $602.3900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 91 103 46.872219 $2392.8100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 32 38 8.200001 $418.6200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 10 2.977777 $152.0100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 45 54 21.316668 $1088.2200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.511111 $26.0900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 215 244 86.542853 $4418.0000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 0.955555 $46.7600 $48.9400
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Subtotal (Total Children Is Unduplicated) 681 1240 1405.535109 $95709.2900 $68.0900
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 2.044444 $102.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.511111 $25.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.600000 $138.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 12 13 8.772223 $438.6200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 2.822222 $70.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 438 531 479.933305 $23996.5300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 391 475 698.294454 $17457.3900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 224 493 372.288850 $18614.2500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 140 290 425.166684 $10629.2100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 64 136 110.244438 $5512.1900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 87 120.990482 $3024.7800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 384 451 399.999984 $19999.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 363 433 606.938899 $15173.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 9 60.999999 $1525.0100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 480 588 5002.936517 $250147.0600 $50.0000
INTR -T1013 INTERPRETER 1 1 12.571429 $628.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 164 194 1129.001583 $80655.9800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 176 235 1916.392861 $109617.7900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 62 79 551.614284 $39407.3800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 52 68 525.035713 $30011.0900 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 3.022222 $1378.1200 $456.0000
SENS -V5264 EARMOLD 4 5 5.111110 $92.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 225 277 2280.390470 $162911.2600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.428571 $81.7200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.142857 $182.4200 $13.8800
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Subtotal (Total Children Is Unduplicated) 808 4377 14731.254712 $792049.0900 $53.7700
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Total 5755 38146.477121 $1700569.3800 $44.5800
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Number of Children (Unduplicated) With at Least One Authorization 956