Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 5955 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 4 4 2.321004 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 2.321004 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 64 83 65.800838 $3191.3400 $48.5000
EXIT -EXIT EXIT ASSESSMENT 97 97 94.785344 $4739.2700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 6.010958 $333.6100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 68 68 111.063009 $8329.7400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 26 26 32.399996 $2430.0200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 98 100 169.112321 $9385.7500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 38 38 72.004110 $5400.3100 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 11 11 10.760427 $549.3200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.522222 $26.6600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 15 7.298630 $372.5900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 35 40 24.265276 $1238.7400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 14 14 5.327095 $271.9600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.044444 $2.2700 $51.0000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 12 12 6.331507 $323.2200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 42 47 29.457667 $1503.8200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.505556 $76.8600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 0.632876 $32.3000 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 44 49 46.918798 $2395.2100 $51.0500
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Subtotal (Total Children Is Unduplicated) 328 622 698.252032 $41575.8100 $59.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 81 102 95.875114 $479375.0000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.227397 $11.3700 $49.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 75 88 151.645702 $7582.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 6 4.061109 $101.5200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 463 609 1419.258168 $70962.6600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.066667 $26.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 235 298 687.104737 $34355.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.066667 $151.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 55 112.999997 $5649.9900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.666667 $41.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 426 523 1086.995181 $54349.4800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 7 9.266668 $231.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 498 631 5106.980936 $255349.0700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 9.428571 $471.4300 $50.0000
INTR -T1013 INTERPRETER 24 36 144.309653 $7215.4900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 522 1083 5929.652585 $59296.4800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 92 109 992.364282 $70894.5100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.285714 $163.2900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 3 23.142857 $1323.7700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 90 111 1060.089281 $75732.7700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 2.714285 $193.9100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 7 37.463601 $2141.4100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 72 83 842.928570 $60218.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 26.285714 $364.8500 $13.8800
TRAV -TRAVS Travel by mile 561 1558 396788.214699 $176570.7600 $0.4500
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Subtotal (Total Children Is Unduplicated) 613 5329 414542.094822 $1362775.6500 $3.2900
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Total 5955 415242.667858 $1404351.4600 $3.3800
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Number of Children (Unduplicated) With at Least One Authorization 616