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 1731 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 17 19 38.403172 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 19 25 35.494064 $1774.7000 $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 4 5 5.010958 $375.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.175342 $163.1500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 4 2.268494 $170.1300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 11 11 8.267124 $458.8200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 0.012329 $0.9200 $74.8200
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 0.006850 $0.5100 $74.4500
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 0.042463 $2.3600 $55.6700
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.505556 $25.8100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 1.695890 $86.5800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.210959 $61.8200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 1.186301 $60.5600 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 55 75 61.876330 $3481.1800 $56.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.505556 $17528.0000 $5000.0600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 33 34 137.792934 $6889.6500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 445 565 779.001005 $38949.9900 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 37 46 313.071427 $15653.5800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 8.785715 $439.2900 $50.0000
INTR -T1013 INTERPRETER 12 13 133.328572 $6666.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 3.033333 $30.3300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 4 10.357143 $739.9100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.285714 $163.2900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 4 5 23.319047 $1665.9100 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 10 54.500000 $3893.4800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.285714 $91.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 9.857143 $136.8200 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 31 35 27.390477 $1013.4500 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 517 1637 2779.376055 $156958.9500 $56.4700
-------------------------------------------------------------------------------------------------------------------------------------
Total 1731 2879.655557 $160440.1400 $55.7200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 536