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: 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 5064 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 31 34 62.366666 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 73 86 17241.461904 $637934.0900 $37.0000
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Subtotal (Total Children Is Unduplicated) 99 120 17303.828570 $637934.0900 $36.8700
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.011111 $45.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.011111 $116.2800 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 21 21 13.720551 $686.0400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 60 61 107.000000 $5350.0000 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 8 8 16.000000 $1200.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 6.011111 $333.6200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 22.000000 $1650.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 166 169 325.032874 $24377.4800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 21 21 40.005479 $3000.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 73 74 145.005479 $10875.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 6 6 12.000000 $666.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 74 74 144.010958 $7992.6100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 60 75 24.665084 $1259.1800 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 13 6.855559 $349.9900 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
OCTH -97167 OT EVAL HIGH COMPLEXITY 95 114 41.529334 $2120.1400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 27 31 84.888892 $4333.5900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 1.516668 $77.4300 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
PSTH -97163 PT EVAL HIGH COMPLEXITY 37 47 24.161116 $1233.4500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.261111 $13.3300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 194 219 83.340877 $4254.6600 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 2.583333 $131.8800 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 2.461111 $125.6400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 7 2.361111 $105.1900 $44.5500
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Subtotal (Total Children Is Unduplicated) 556 992 1139.660648 $72509.4500 $63.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.505556 $2528.0000 $5000.4400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.011111 $50.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.011111 $50.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 3 3.033334 $697.6800 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 11 11 17.861113 $893.0700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 383 477 377.538074 $18876.8000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 0.305556 $15.2800 $50.0100
CONIP -CONIP CONSULT, ITDS PHONE 330 415 621.227776 $15530.7000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 186 402 268.606340 $13430.2800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 0.277778 $13.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 121 233 296.869050 $7421.7300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 55 121 90.911113 $4545.5700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 98 95.050002 $2376.2600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 327 406 319.261096 $15962.9800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.316667 $15.8400 $50.0100
CONSP -CONSP CONSULT, SLP, PHONE 302 375 499.403972 $12485.1200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 5 28.999999 $725.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 402 508 3901.571427 $195078.5300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 70 75 726.571429 $36328.5800 $50.0000
INTR -T1013 INTERPRETER 2 2 22.571429 $1128.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 104 129 901.783333 $64423.3900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 14 14 142.604761 $10187.6900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 133 182 1318.611900 $75424.6100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 12 12 95.285715 $5450.3400 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 13.000000 $928.7200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 45 55 425.357141 $30387.5100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 3 27.285714 $1949.2900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 47 63 494.071428 $28241.1200 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 5 52.285715 $2988.6500 $57.1600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 13.000000 $743.0800 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.011111 $461.0600 $456.0000
SENS -V5264 EARMOLD 3 4 5.055556 $91.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 215 258 2036.409518 $145481.1300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 24 25 250.571428 $17900.8200 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 5 48.428572 $3459.7300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 35.428571 $2531.0300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 21.000000 $291.4800 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.857143 $25.7800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 34 45 392.167462 $14510.2100 $37.0000
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Subtotal (Total Children Is Unduplicated) 722 3952 13549.119001 $733656.6000 $54.1500
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Total 5064 31992.608219 $1444100.1500 $45.1400
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Number of Children (Unduplicated) With at Least One Authorization 843