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
Eligibility Filter: Program Patients
With the filters selected there were 2902 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 30 30 44.549207 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 30 30 44.549207 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 20.872223 $1565.4200 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 5 5 8.005479 $600.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 58 58 96.156545 $5336.6900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 8 8 6.577626 $365.0600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 18 18 35.000000 $2625.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 28 28 52.106849 $3908.0100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 14 14 27.000000 $2025.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 12.505479 $937.9100 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 35 35 63.109589 $4733.2100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 30 30 53.505479 $2969.5600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 22 22 41.002740 $2275.6500 $55.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 10 16.335768 $833.9400 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 0.763166 $38.9600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 2.038889 $104.0900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.164384 $8.3900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 161 268 456.144216 $29871.8600 $65.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 1.479452 $7397.5000 $5000.1600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 35 40 52.167496 $2608.3900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 30 36 40.020635 $2001.0400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 3.066667 $76.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 586 719 1056.193912 $52809.8100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 96 103 128.416676 $6420.8800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 211 248 350.916665 $17545.8300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 34 37 60.907142 $3045.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 7.117460 $177.9400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 235 282 395.685643 $19784.3600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 59 67 96.537305 $4826.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.516667 $12.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 480 572 818.806754 $40940.3700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 88 93 164.070640 $8203.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 6.144444 $153.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 198 236 1859.195225 $92959.9300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 84 93 695.688885 $34784.5000 $50.0000
INTR -T1013 INTERPRETER 2 3 26.285714 $1314.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 11 89.923809 $6424.1800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 8.714286 $622.5500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 5 54.571428 $3898.6000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 29.000000 $1657.6500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 12 103.999998 $7429.7700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 16.428572 $1173.6600 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 19.571428 $1398.1900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.428571 $459.2600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 24.000000 $333.1200 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 15 16 32.966668 $1219.7700 $37.0000
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Subtotal (Total Children Is Unduplicated) 708 2604 6161.964999 $320619.4500 $52.0300
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Total 2902 6662.658422 $350491.3100 $52.6100
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Number of Children (Unduplicated) With at Least One Authorization 778