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
Eligibility Filter: Program Patients
With the filters selected there were 2850 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 58 61 653.477779 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 6 6 1260.000000 $46620.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 64 67 1913.477779 $46620.0000 $24.3600
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 37 39 37.385844 $1869.2900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 3 6.000000 $300.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 62 65 117.142857 $5857.1500 $50.0000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 0.011111 $0.6200 $55.4400
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 13 13 26.000000 $1950.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 16.000000 $888.0000 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 11 12 8.179365 $417.5500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 2.511111 $128.1900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 9 2.827778 $144.3600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 4 0.783333 $39.9900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 6 3.472222 $177.2600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 18 19 9.951587 $508.0200 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $26.0900 $51.0500
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Subtotal (Total Children Is Unduplicated) 153 198 258.937430 $14297.7300 $55.2200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.000000 $20000.0000 $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 7 10 4.394443 $219.7200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 6 5.000000 $250.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 8 10 3.105559 $77.6500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 349 425 347.372201 $17368.5100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 4 5 3.066666 $153.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 316 370 480.953959 $12023.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 200 413 316.519019 $15825.8200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 1.261111 $63.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 107 212 289.701601 $7242.5700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 55 132 94.855556 $4742.7800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 104 122.094443 $3052.3600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 300 351 297.922202 $14896.0100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 5 5 3.005555 $150.2800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 301 346 414.799989 $10369.9700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 3 10.879365 $271.9800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 99 112 1062.874594 $53143.8100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 41.142857 $2057.1500 $50.0000
INTR -T1013 INTERPRETER 2 3 6.285714 $314.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 10 63.571429 $4541.5400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.000000 $71.4400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 53.314287 $3049.5700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 3 3 27.714285 $1979.9200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 40.142857 $2294.5700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 38 318.571428 $22758.7600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $938.9300 $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) 602 2585 4034.366580 $198238.5500 $49.1400
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Total 2850 6206.781789 $259156.2800 $41.7500
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Number of Children (Unduplicated) With at Least One Authorization 693