Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 8523 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 95 106 485.318252 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 28 33 1110.050800 $41071.8700 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 119 139 1595.369052 $41071.8700 $25.7400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 49 66 55.141706 $2674.3800 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.7100 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.4900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 3.450000 $81.7700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.000000 $9.0800 $9.0800
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $38.4700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 3 3.000000 $254.5200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 5.142857 $262.6500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $16.7000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $22.4000 $22.4000
EXIT -EXIT EXIT ASSESSMENT 144 146 292.000000 $14600.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 18 18 33.500000 $2512.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 3.500000 $262.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 26 39 72.500000 $5437.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 13 14 27.500000 $1526.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 151 151 290.000000 $21750.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 10 10 20.000000 $1500.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 54 54 104.000000 $7800.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 212 213 406.000000 $22533.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 183 204 387.133334 $29035.0100 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 7 7 13.000000 $975.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 3.572603 $182.3800 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.175342 $8.9500 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $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 2.000000 $102.1000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 9 13.714285 $700.1200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 13 8.802740 $449.3800 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 3.714286 $189.6200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 4.000000 $178.2000 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 572 1004 1805.847153 $116145.3300 $64.3200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 38 46 51.702816 $258514.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 6 5.405556 $270.2800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 11 12 17.000000 $3910.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 232 274 331.138204 $16556.9000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 6 1.526026 $76.3100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 52 57 66.491260 $1662.2900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 224 286 699.351602 $34967.6600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 8 8 12.750001 $637.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 11 16.333333 $408.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 77 102 237.333335 $11866.6800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 7.200000 $360.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 32.914287 $822.8600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 118 151 345.296044 $17264.8600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 3 3 3.466666 $173.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 11.133334 $278.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 159 202 459.831756 $22991.6400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 3 3 6.800000 $340.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 15.366668 $384.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1042 1318 10465.431679 $523272.1200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 14 14 102.028570 $5101.4400 $50.0000
INTR -T1013 INTERPRETER 154 196 932.690496 $46634.5600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1172 2113 14630.753913 $146307.6900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 85 623.152382 $44518.0400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 11.428571 $653.7200 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 3 4 26.171428 $1869.6900 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 12.409524 $886.5400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 101 134 1099.180950 $78525.5600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 13.142857 $938.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 5.266667 $301.0400 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 10.571428 $755.2300 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 9.999999 $714.4000 $71.4400
SENS -V5264 EARMOLD 2 2 3.318722 $59.7400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 130 167 1384.923805 $98939.0400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 8 59.333333 $4238.7800 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 2 13.142857 $938.9200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 7 8 68.428572 $4888.5400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 11 12 90.714285 $1259.1200 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.571429 $77.3300 $13.8800
TRAV -TRAVS Travel by mile 1172 2117 14644.811057 $6516.9500 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1237 7380 46546.656269 $1339821.4400 $28.7800
-------------------------------------------------------------------------------------------------------------------------------------
Total 8523 49947.872474 $1497038.6400 $29.9700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1364