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 1501 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 23 23 34.960319 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 5.874201 $326.0200 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 1.002740 $55.6500 $55.5000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 0.500000 $37.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 2.500000 $138.7500 $55.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 4 12.678234 $647.2200 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 12 19 26.071765 $1432.6900 $54.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.279452 $1397.5000 $5000.8600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 30 38.879400 $1943.9800 $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 16 19 163.714285 $8185.7300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 38.571428 $1928.5800 $50.0000
INTR -T1013 INTERPRETER 2 3 26.285714 $1314.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 3 30.571428 $2184.0300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 8.714286 $622.5500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 13.142857 $938.9300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 12.000000 $857.2800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 8.714286 $622.5500 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 9 10 19.428573 $718.8600 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 440 1459 2314.618813 $118103.7500 $51.0300
-------------------------------------------------------------------------------------------------------------------------------------
Total 1501 2375.650897 $119536.4500 $50.3200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 460