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: 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 3495 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 22 24 48.715875 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 2.022222 $74.8200 $37.0000
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Subtotal (Total Children Is Unduplicated) 24 26 50.738097 $74.8200 $1.4700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 2 2.000000 $97.0000 $48.5000
EXIT -EXIT EXIT ASSESSMENT 11 12 19.200000 $960.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 8.000000 $600.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 19.005479 $1425.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 4.011111 $300.8300 $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 5 5 9.000000 $675.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 5.015221 $376.1400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 7 3.013700 $226.0100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 52 54 95.953424 $5325.4100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 12 12 17.013698 $944.2600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 16.002740 $1200.2000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 8 8 8.510960 $638.3200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 7.002740 $525.2000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 2.002740 $150.2000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 23 23 11.069867 $830.2300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 24 24 28.563015 $1585.2400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 11.502740 $638.4000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 6.479452 $485.9600 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 14 7.036379 $359.2100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 68 71 38.755867 $1978.5000 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.194444 $9.9200 $51.0400
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 0.538889 $27.5100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.005556 $0.2900 $51.4600
PSTH -97161 PT EVAL LOW COMPLEXITY 2 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 11 7.155556 $365.2900 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 66 69 51.684847 $2638.5200 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.084932 $4.3300 $51.0300
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 3 0.475037 $24.2500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.022222 $1.1300 $51.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 4.294444 $219.2300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 136 145 129.035148 $6587.2800 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.754871 $38.5400 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.522222 $77.7100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 5 6 4.438204 $226.5700 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.188889 $9.6400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 21 23 19.620548 $874.1000 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 343 574 548.499386 $30968.2500 $56.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 16 15.601598 $78007.5000 $4999.9700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 23 93.313415 $4665.6600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 13 14 11.321102 $566.0600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 406 505 762.113875 $38105.6300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 34 43 48.884922 $2444.2500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.466667 $36.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 136 164 196.661906 $9833.1100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 13 15 16.177777 $808.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 15.847619 $396.1900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 190 225 330.736497 $16536.7600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 16 19 20.577776 $1028.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.016667 $0.4200 $25.0500
CONSF -CONSF CONSULT, SLP, FACE TO FACE 317 389 480.121824 $24006.0900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 27 29 35.586508 $1779.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 10.138888 $253.4700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 12 96.142856 $2403.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 428 545 3894.134913 $194706.7400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 141 169 1332.285712 $66614.3100 $50.0000
INTR -T1013 INTERPRETER 6 8 47.285714 $2364.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 1.466667 $14.6700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 89 109 748.492062 $53472.2600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 30 40 287.069840 $20508.2700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 8 8 71.807143 $4107.3700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 6.500000 $464.3600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 9 10 49.428571 $3531.1700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 101 118 870.954762 $62221.0400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 22 24 145.619047 $10403.0400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 14 14 106.499999 $6087.5500 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 11.571429 $661.4200 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 7.233333 $516.7500 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 7 9 61.285714 $4378.2600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 179 212 1451.276186 $103679.2000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 49 55 427.039679 $30507.7400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 5.428572 $310.5200 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.642857 $117.3700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 13 15 94.928572 $6781.6900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 22 25 179.071427 $2485.5100 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 54 62 298.363092 $11039.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 546 2895 12234.095188 $765845.3900 $62.6000
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Total 3495 12833.332671 $796888.4500 $62.1000
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Number of Children (Unduplicated) With at Least One Authorization 586