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
Eligibility Filter: Program Patients
With the filters selected there were 5916 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 36 39 64.860320 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 28.022222 $1036.8200 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 40 43 92.882542 $1036.8200 $11.1600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 2 2.000000 $97.0000 $48.5000
EXIT -EXIT EXIT ASSESSMENT 32 35 60.200000 $3010.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 14 14 22.123288 $1659.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 20 20 33.544291 $2515.8200 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 7 7 5.019407 $376.4600 $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 0.005556 $0.4200 $75.5900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 13 20.837378 $1562.8100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 8 8 7.024810 $526.8600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 13 5.556166 $416.6900 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 1.010959 $75.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 84 86 144.549316 $8022.4800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 29 29 28.613698 $1588.0500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 16 16 25.501370 $1912.6000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 38 41 30.106850 $2258.0200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 9.002740 $675.2000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 5.002740 $375.2000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 40 40 20.615073 $1546.1200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 38 38 40.094522 $2225.2400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 30 32 17.609588 $977.3400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 6.578082 $493.3700 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.000000 $225.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 22 24 14.350991 $732.6300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 103 107 63.793995 $3256.7000 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 0.706925 $36.0800 $51.0400
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.194444 $9.9200 $51.0400
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 3 3 1.538889 $78.5600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 2.000000 $102.1000 $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 13 13 8.383334 $427.9700 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 94 97 75.830727 $3871.1600 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 1.279376 $65.3100 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 3 0.475037 $24.2500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.022222 $52.1800 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 5.294444 $270.2800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 206 217 176.036303 $8986.6800 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.260427 $115.4000 $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 6 7 5.438204 $277.6200 $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 30 32 27.869863 $1241.6000 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 578 960 886.532126 $50738.8200 $57.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 36 39 38.425929 $192129.0000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 34 35 106.938594 $5346.9200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 26 29 25.509915 $1275.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 647 812 1284.262284 $64213.0300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 60 73 91.323810 $4566.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.466667 $36.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 235 289 365.344042 $18267.1900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 27 29 29.216665 $1460.8300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 19.880952 $497.0200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 285 345 549.929348 $27496.3700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 28 31 41.383331 $2069.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.350000 $58.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 542 663 849.286107 $42464.2900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 45 47 66.508728 $3325.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 10.138888 $253.4700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 16 18 121.999999 $3050.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 649 829 5902.146020 $295107.2800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 272 327 2615.711106 $130785.6100 $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 158 195 1298.884923 $92792.3100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 53 69 478.141268 $34158.4100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 8 8 71.807143 $4107.3700 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 26.000000 $1487.2000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 6.500000 $464.3600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 19 20 136.285712 $9736.2400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 183 216 1569.177778 $112102.0900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 51 56 423.542857 $30257.9200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 16 16 123.071428 $7034.7700 $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 14 16 125.857143 $8991.2400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 333 406 2797.498410 $199853.3000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 125 144 1120.470632 $80046.4300 $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 2 2 7.357143 $525.6000 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 34 37 245.752383 $17556.5400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 34 37 274.928569 $3816.0100 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 79 96 471.501188 $17445.5500 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 870 4913 21371.584677 $1416645.6500 $66.2900
-------------------------------------------------------------------------------------------------------------------------------------
Total 5916 22350.999345 $1468421.2900 $65.7000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 940