Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 5018 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 4 4 14.030158 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 14.030158 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 63 84 67.648325 $3280.9300 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 3 0.366666 $18.3300 $49.9900
EXIT -EXIT EXIT ASSESSMENT 90 90 88.842707 $4442.1400 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 22 22 44.000000 $3300.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.500000 $637.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 21 21 33.021916 $2476.6400 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 56 57 110.951857 $6157.8300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $777.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 25.500000 $1912.5000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 10 15.571539 $794.9400 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.150685 $7.6900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.505556 $76.8600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 15 17 13.611124 $694.8600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 38 44 38.140562 $1947.0700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 12 15 4.504874 $229.9900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 4.982269 $254.3500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 39 47 36.604568 $1868.6600 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 5.438889 $277.6600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.375342 $19.1600 $51.0400
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 42 51 28.474487 $1453.6200 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.112329 $158.8800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.081801 $137.2900 $44.5500
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Subtotal (Total Children Is Unduplicated) 266 522 571.385496 $32507.9400 $56.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 80 107 81.244302 $406220.0000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 68 81 122.370469 $6118.5200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 3.849999 $192.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 16 16 14.220835 $355.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 399 529 1172.056413 $58602.6200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 3.033333 $151.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 219 277 673.023786 $33651.0700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 10.266667 $256.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 42 53 104.499995 $5224.9800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.033333 $75.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 357 455 882.919002 $44145.7300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 15.999998 $400.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 424 542 4191.742842 $209587.1700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 72.500000 $3625.0000 $50.0000
INTR -T1013 INTERPRETER 17 24 116.549205 $5827.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 439 932 5032.966625 $50329.6500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 86 113 882.398410 $63038.5600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 30.285714 $2163.6100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 6 65.142857 $3726.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 86 111 905.259016 $64671.7100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 6 6 53.714286 $3837.3400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 7 51.977886 $2971.0600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 78 91 712.864283 $50927.0000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 9.428571 $673.5800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 79.285714 $1100.4900 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 415 1099 314866.605355 $140115.6400 $0.4500
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Subtotal (Total Children Is Unduplicated) 502 4492 330158.238896 $1158026.5300 $3.5100
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Total 5018 330743.654550 $1190534.4700 $3.6000
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Number of Children (Unduplicated) With at Least One Authorization 531