Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 2018 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 49 51 549.777779 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 91.000000 $3367.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 50 52 640.777779 $3367.0000 $5.2500
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 30 32 30.074733 $1503.7300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 3 6.000000 $300.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 51 53 94.142857 $4707.1500 $50.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.738889 $37.7200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.650000 $33.1800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.172222 $8.7900 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.683333 $85.9300 $51.0500
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Subtotal (Total Children Is Unduplicated) 92 108 154.623145 $8196.7800 $53.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.733333 $36.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.655556 $32.7800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 5 2.811111 $140.5600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 5 4.000000 $200.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 6 1.533335 $38.3400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 270 332 272.822208 $13641.0400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 3 1.022222 $51.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 238 284 392.365071 $9809.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 150 302 240.146804 $12007.2400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 1.261111 $63.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 86 171 238.173820 $5954.3700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 100 70.888892 $3544.4600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 31 76 94.616669 $2365.4200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 230 273 232.161096 $11607.9800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 0.861111 $43.0600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 224 263 329.566658 $8239.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 9 138.571427 $6928.5800 $50.0000
INTR -T1013 INTERPRETER 2 3 6.285714 $314.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 12.714285 $908.3100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 17.571429 $1005.0800 $57.2000
PHY -97110HM PT SESSION BY PT ASST 1 1 13.142857 $751.2500 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 10 84.714285 $6051.9800 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $163.2900 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 4.000000 $148.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 438 1858 2165.904708 $99045.1000 $45.7300
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Total 2018 2961.305632 $110608.8800 $37.3500
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Number of Children (Unduplicated) With at Least One Authorization 508