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: 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 3871 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 5 5 108.103176 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 108.103176 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 49 73 67.370484 $3267.4800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 2.424658 $136.9700 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.252055 $5.9700 $23.7000
EVAL -96111 DEVELOPMENTAL EVALUATION 4 5 2.194445 $109.7300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 49 49 48.777397 $2438.8700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 8 16.000000 $888.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 60 60 110.027395 $8252.0600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 28 29 54.487671 $4086.5800 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 102 103 189.549311 $10520.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 23 23 43.516437 $3263.7400 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 7 1.974277 $100.7800 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.161644 $8.2500 $51.0400
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 2.622223 $133.8700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 14 18.929692 $966.3700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 29 31 29.537073 $1507.8800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 10 2.618722 $133.6800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 10 11 2.778616 $141.8500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 26 31 18.775570 $958.4900 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 5 6 6.000000 $306.3000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 4.252055 $217.0700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 51 54 30.538815 $1559.0300 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.136986 $6.9900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 7 13.496369 $601.2600 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 2.000000 $89.1000 $44.5500
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Subtotal (Total Children Is Unduplicated) 270 547 679.427374 $40414.6100 $59.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 62 90 99.674722 $498374.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 49 54 53.458516 $2672.9300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 2.673611 $133.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 5 2.079167 $51.9800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 308 386 828.388494 $41419.6300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 4.533334 $226.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 162 198 408.261921 $20413.1800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 5.166667 $258.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 6 11.433334 $285.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 30 36 68.666670 $3433.3500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 5.133334 $128.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 275 327 654.347648 $32717.5400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 6 6 14.633335 $731.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 15.366668 $384.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 318 387 3091.195209 $154560.0000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 39.857143 $1992.8600 $50.0000
INTR -T1013 INTERPRETER 15 26 147.116436 $7355.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 345 726 4080.967387 $40809.7700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 67 87 750.368249 $53606.3500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 6.285714 $449.0600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 7 60.428572 $3456.5100 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 3.857143 $275.5500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 66 85 762.275927 $54457.0300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 6 36.142857 $2582.0500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 13.142857 $751.2500 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 4.285714 $244.9700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 93 110 1001.938087 $71578.5700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 14.428571 $1030.7800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 41.714285 $579.0000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 310 742 222593.446563 $99054.0900 $0.4500
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Subtotal (Total Children Is Unduplicated) 406 3319 234822.268135 $1094052.4400 $4.6600
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Total 3871 235609.798685 $1134467.0500 $4.8200
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Number of Children (Unduplicated) With at Least One Authorization 446