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
Eligibility Filter: Program Patients
With the filters selected there were 6095 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 31 34 56.517455 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 16.758731 $620.0700 $37.0000
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Subtotal (Total Children Is Unduplicated) 35 38 73.276186 $620.0700 $8.4600
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 54 65 104.527397 $5226.3600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 6 6.931507 $519.8600 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 36 37 43.050685 $3228.7900 $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 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 14.179452 $1063.4600 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 18 21 8.895057 $667.1000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 95 97 76.204062 $4229.2700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 6 4.010960 $222.6000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 103 108 0.910977 $68.2000 $74.8600
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 0.013699 $1.0300 $75.0100
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 56 56 0.224665 $16.8000 $74.7800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 123 123 2.700013 $149.7300 $55.4600
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 21 21 0.358909 $26.8700 $74.8500
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.002740 $0.2000 $73.9100
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 28 28 17.539346 $895.3900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 138 145 88.346652 $4510.1100 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.116667 $5.9600 $51.0600
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 12 12 8.416667 $429.6700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 105 108 89.498730 $4568.9400 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 4.107001 $209.6600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 13 13 11.656393 $595.0600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 257 270 193.230207 $9864.4100 $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 30 30 37.885802 $1687.8100 $44.5500
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Subtotal (Total Children Is Unduplicated) 676 1184 732.710175 $39442.8200 $53.8300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 52 54 46.460884 $232304.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 52 53 159.085629 $7954.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 2 0.900000 $45.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 705 899 1250.958848 $62547.8500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 17 17 7.512698 $375.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 4 5.866667 $146.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 266 331 419.732473 $20986.5400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.919047 $45.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 10.300000 $257.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 292 366 690.447496 $34522.3100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 6 6 2.055556 $102.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 586 751 997.454790 $49872.6000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 11 11 2.361111 $118.0600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 8.872221 $221.8000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 29 36 292.000001 $7300.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 702 896 6730.731736 $336536.5700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 134 136 286.117460 $14305.9100 $50.0000
INTR -T1013 INTERPRETER 13 15 147.328572 $7366.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 3.033333 $30.3300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 169 221 1667.170400 $119102.6700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 36 37 67.490478 $4821.5200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 11 61.997618 $3546.2700 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 8.000000 $457.6000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.571429 $40.8200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 210 263 2012.819839 $143795.8800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 30 31 43.619047 $3116.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 21 22 178.357142 $10194.9000 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 5.428571 $387.8200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 392 501 3655.689683 $261162.4900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 75 77 124.928569 $8924.9500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 10 10 6.785713 $484.7800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 48 49 437.357143 $6070.5100 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 47 56 47.319050 $1750.8100 $37.0000
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Subtotal (Total Children Is Unduplicated) 928 4873 19379.673204 $1338897.8800 $69.0900
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Total 6095 20185.659565 $1378960.7700 $68.3100
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Number of Children (Unduplicated) With at Least One Authorization 999