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: 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 5813 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 25 29 30.380953 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 80 98 23294.300000 $861889.1000 $37.0000
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Subtotal (Total Children Is Unduplicated) 99 127 23324.680953 $861889.1000 $36.9500
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 1.011112 $45.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 0.988890 $113.7400 $115.0100
EVAL -96111 DEVELOPMENTAL EVALUATION 28 31 25.693152 $1284.6700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 49 50 81.344445 $4067.2300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 14 14 28.000000 $2100.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 14.005479 $1050.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 12.000000 $900.0000 $75.0000
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 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 155 156 308.027701 $23102.0800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 121 121 230.049617 $17253.7300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 47 47 93.000000 $6975.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 65 66 124.021916 $6883.2200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 20.000000 $1500.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 63 69 25.620643 $1307.9800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 18 25 7.372222 $376.3500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 104 119 55.005569 $2808.1000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 28 32 7.272226 $371.2700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 8 2.133333 $108.9100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 49 55 26.922226 $1374.4000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 0.788890 $40.2800 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 225 258 83.832560 $4279.7500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 1.377778 $61.3800 $44.5500
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Subtotal (Total Children Is Unduplicated) 590 1091 1154.473238 $76376.2900 $66.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.344444 $1722.0000 $4999.3600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 1.266668 $63.3400 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.466667 $23.3400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.488889 $572.4500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 17 16.298810 $814.9400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 1.672223 $41.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 425 549 472.136491 $23606.7400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 380 497 705.037304 $17625.9300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 223 503 347.283329 $17364.1500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 147 305 375.877780 $9396.9500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 119 89.555558 $4477.7900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 35 81 120.522225 $3013.0600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 375 473 394.047606 $19702.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 353 453 599.101592 $14977.5400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 9 70.285714 $1757.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 470 607 4975.426995 $248771.3300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 54 55 51.285712 $2564.3000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 143 184 1075.265079 $76816.9600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 9 9 12.857142 $918.5100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 170 223 1694.945238 $96950.8700 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 8 8 5.571428 $318.6800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 52 69 511.544047 $36544.7200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 4 4 3.000000 $214.3200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 46 61 522.607140 $29872.2300 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 4 2.857143 $163.3200 $57.1600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 1.714286 $97.9900 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 1.011112 $461.1100 $456.0400
SENS -V5264 EARMOLD 4 5 4.222223 $76.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 220 288 2127.354762 $151978.2000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 19 19 18.000000 $1285.9300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.142857 $65.3700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 12.000000 $857.2800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 9.571428 $132.8500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 26 35 28.485713 $1054.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 779 4595 14256.247605 $764531.4500 $53.6300
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Total 5813 38735.401796 $1702796.8300 $43.9600
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Number of Children (Unduplicated) With at Least One Authorization 888