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: 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 3217 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 23 23 34.960319 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 23 23 34.960319 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 22.000000 $1650.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 5.005479 $375.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 1.005479 $75.4100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 6 6 9.005479 $675.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 63 64 99.744064 $5535.8000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 8 8 9.010959 $500.1000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 24 24 39.590411 $2969.2800 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 48 48 70.074123 $5255.5700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 11 11 21.000000 $1575.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 11.002740 $825.2000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 59 60 94.054794 $7054.1100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 39 41 66.653424 $3699.2600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 24 24 38.019177 $2110.0700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 2.794444 $142.6500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 54 56 44.938715 $2294.1300 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 1.294444 $66.0800 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.316667 $16.1700 $51.0600
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 1.022222 $52.1800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 3.000000 $153.1500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 14 15 6.461112 $329.8400 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 3 3 0.800000 $40.8400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 47 51 47.235389 $2411.3700 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 0.607610 $31.0200 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 4 4 0.552436 $28.2100 $51.0600
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 92 95 45.889348 $2342.6700 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 3.783333 $193.1400 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 9 10 5.118721 $261.3100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 4 3.094444 $157.9700 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.327778 $16.7300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 17 17 12.959742 $577.3500 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.355556 $60.3900 $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) 332 608 688.884680 $42957.1700 $62.3600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 19 18.450229 $92251.5000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 27 31 39.612733 $1980.6500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 18 21 18.511111 $925.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 3.066667 $76.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 373 468 662.202792 $33110.2100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 56 62 71.906356 $3595.3500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 123 145 198.981745 $9949.0700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 17 20 34.396030 $1719.7900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 5.661904 $141.5500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 155 187 262.696838 $13134.9100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 41 49 72.509527 $3625.4900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 303 365 525.610324 $26280.5400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 54 58 94.440477 $4722.0300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 4.333333 $108.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 415 526 4053.793623 $202690.0000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 107 121 890.443567 $44522.2500 $50.0000
INTR -T1013 INTERPRETER 2 3 26.285714 $1314.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 89 105 869.902380 $62145.8600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 11 11 52.986508 $3785.3600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 15.857143 $907.0300 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 13.142857 $751.7700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 3 3 32.857143 $2347.3200 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 13 14 104.034922 $7432.2500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 73 95 688.911904 $49215.9000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 10 11 62.395239 $4457.5100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 36.714286 $2098.5900 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 4 6 27.704763 $1979.2300 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 16 17 147.285715 $10522.1000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 139 164 1123.598410 $80269.9900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 15 16 75.950001 $5425.8600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 10.857143 $621.0300 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 5.000000 $286.0000 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 5 43.428571 $3102.5400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 14 14 104.638095 $7475.3600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 17 18 131.423809 $1824.1600 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 13.428571 $186.3900 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 9 10 19.428573 $718.8600 $37.0000
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Subtotal (Total Children Is Unduplicated) 497 2586 10562.449003 $685701.2800 $64.9200
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Total 3217 11286.294002 $728658.4500 $64.5600
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Number of Children (Unduplicated) With at Least One Authorization 553