Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 4244 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 1 1 0.084932 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.084932 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 35 53 39.233486 $1902.8300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 3 2.252055 $125.4600 $55.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 3 3.000000 $43.7400 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 5 3.290411 $77.3300 $23.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.722222 $32.5000 $45.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.494444 $24.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 55 55 60.759686 $3037.9900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 77 77 131.280034 $9846.0200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 48.214286 $3616.0700 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.500000 $337.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 95 99 175.994320 $9767.7000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.500000 $83.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 26 29 58.000000 $4350.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 4 1.607611 $82.0700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 6 7 6.327778 $323.0300 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 2 0.511111 $26.0900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 13 14 7.492999 $382.5200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 50 60 40.676409 $2076.5400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 3 1.252055 $63.9100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 14 15 10.096455 $515.4300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 25 33 15.710351 $802.0200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 13 14 14.000000 $714.7000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 36 41 25.768418 $1315.4800 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.252055 $12.8700 $51.0600
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.488889 $24.9600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 19 23 9.626560 $428.8600 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 2.252055 $100.3300 $44.5500
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Subtotal (Total Children Is Unduplicated) 280 583 680.814801 $41124.0700 $60.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 43 65 62.323147 $311616.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.166667 $108.3400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 3 2.252055 $155.0800 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 2.974277 $684.0900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 40 40 47.713777 $2385.7000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 5 7.000000 $350.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 5.822223 $145.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 345 485 1117.660750 $55883.2100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 6.133334 $306.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.800000 $45.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 168 216 457.614303 $22880.7900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 30 32 87.919052 $4395.9800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.133333 $153.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 44 110.619054 $5530.9800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 5 7.266666 $181.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 299 388 808.304794 $40415.4000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 7 9 16.866668 $843.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 3.100000 $77.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 357 460 3871.242835 $193562.4400 $50.0000
INTR -T1013 INTERPRETER 16 26 107.483821 $5374.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 353 757 4566.409528 $45664.1800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 84 104 973.257137 $69529.5900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 9 12 92.142856 $6582.7000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 60.785714 $3476.9500 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 11.142857 $796.0500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 57 74 716.176188 $51163.7100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 3 11.642857 $831.7700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 6 52.709525 $3012.8800 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 13.142857 $751.2500 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 87 104 961.352375 $68679.1100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 12.620635 $901.6200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 13.142857 $751.7700 $57.2000
SPL -92508HA GROUP SPL SESSION PER CHILD 6 8 80.285714 $1114.3700 $13.8800
TRAV -TRAVS Travel by mile 349 783 229034.564821 $101920.3800 $0.4500
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Subtotal (Total Children Is Unduplicated) 421 3660 243333.772677 $1000517.6000 $4.1100
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Total 4244 244014.672410 $1041641.6700 $4.2700
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Number of Children (Unduplicated) With at Least One Authorization 456