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 3254 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 24 28 27.380953 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 621.000000 $22977.0000 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 27 31 648.380953 $22977.0000 $35.4400
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.255556 $29.3900 $115.0200
EVAL -96111 DEVELOPMENTAL EVALUATION 28 31 25.693152 $1284.6700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 47 48 77.344445 $3867.2300 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.366667 $18.7200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 5 2.200000 $112.3100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.505556 $25.8100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 3.144446 $160.5300 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 93 112 142.509822 $7910.7100 $55.5100
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
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 1 1 6.000000 $150.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 22 29 227.142858 $11357.1400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 3.285714 $164.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 46.000000 $3286.2400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 7 10 70.142857 $4012.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1 1 10.142857 $724.6100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 25.571428 $1461.6700 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 1 1 0.255556 $4.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 14 115.142858 $8225.7900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.714286 $51.0300 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 25 34 28.199999 $1043.4300 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 592 3111 3656.742443 $143515.5300 $39.2500
-------------------------------------------------------------------------------------------------------------------------------------
Total 3254 4447.633218 $174403.2300 $39.2100
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 632