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: 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 3676 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 17 19 38.403172 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 1.044445 $38.6500 $37.0000
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Subtotal (Total Children Is Unduplicated) 19 21 39.447617 $38.6500 $0.9800
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 27 34 49.494064 $2474.7000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 22 23 30.021918 $2251.6400 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 10.175342 $763.1500 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 14 16 8.637522 $647.7900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 48 49 44.616388 $2476.1700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 2.008220 $111.4500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 52 54 0.179467 $13.3500 $74.3900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 32 32 0.121922 $9.1100 $74.6800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 70 70 0.472615 $26.1200 $55.2700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 0.326030 $24.4200 $74.9000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 17 10.163319 $518.8500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 93 100 54.412633 $2777.7700 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.116667 $5.9600 $51.0600
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 5.911111 $301.7600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 78 81 61.065549 $3117.4100 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 2.107001 $107.5600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 9 9 7.656393 $390.8600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 173 183 135.783553 $6931.7600 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.183333 $9.3600 $51.0400
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 5 5 3.713775 $189.5900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 21 21 31.510459 $1403.7900 $44.5500
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Subtotal (Total Children Is Unduplicated) 425 739 471.677281 $25407.8100 $53.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 23 21.068570 $105343.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 33 34 137.792934 $6889.6500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 447 567 782.467672 $39123.3200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 11 11 3.923809 $196.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 3.066667 $76.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 154 192 224.755900 $11237.7900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.919047 $45.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 8.800000 $220.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 195 241 439.021418 $21951.0300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 4 4 1.622222 $81.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 349 445 580.964325 $29048.1400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 5 5 0.816666 $40.8300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 7.972221 $199.3000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 18 24 180.857143 $4521.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 457 586 4425.714278 $221285.7300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 72 74 174.228571 $8711.4600 $50.0000
INTR -T1013 INTERPRETER 12 14 146.328572 $7316.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 3.033333 $30.3300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 90 117 879.129370 $62805.0100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 23 23 39.561905 $2826.3000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 8 9 54.426190 $3113.1800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.571429 $40.8200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 122 152 1161.778569 $82997.4900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 13 13 24.138096 $1724.4300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 16 17 150.785714 $8618.9200 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 201 249 1755.612696 $125420.9900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 34 34 64.857142 $4633.4100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 2.142857 $153.0900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 27 28 248.500000 $3449.1800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 31 35 27.390477 $1013.4500 $37.0000
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Subtotal (Total Children Is Unduplicated) 578 2916 11552.247793 $753114.5800 $65.1900
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Total 3676 12063.372691 $778561.0400 $64.5400
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Number of Children (Unduplicated) With at Least One Authorization 619