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: 10-01-21 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 2796 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 31 32 47.751588 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 31 32 47.751588 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 8 8 13.283333 $996.2500 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 0.022222 $1.6700 $74.9300
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 6 6 4.172907 $312.9600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 36 37 69.815124 $3874.7400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 2.230137 $123.7700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 21 22 43.000000 $3225.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 48 49 68.683760 $5151.2600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 16 16 31.000000 $2325.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 4 4 7.000000 $525.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 10 16.000000 $1200.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 59 59 91.963211 $6897.2300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 34 35 65.642857 $3643.1800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 65 65 104.358905 $5791.9100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 2.002740 $150.2000 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.716667 $35.8400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 14 5.994445 $306.0200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 56 58 44.073591 $2249.9500 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.500000 $25.5300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.0900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 12 5.177777 $264.3200 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.127778 $6.5200 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 41 42 49.988454 $2551.9100 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 5.900000 $301.2000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 68 70 40.631735 $2074.2400 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 0.771918 $39.4100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 4 4 2.533333 $129.3300 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.511111 $26.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 11 11 8.761110 $390.3000 $44.5500
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Subtotal (Total Children Is Unduplicated) 314 557 703.374226 $43899.0900 $62.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 13 9.157687 $45788.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 29 34 37.788889 $1889.4500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 13 16 9.549999 $477.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 370 452 715.388907 $35769.5200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 49 57 98.753177 $4937.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 179 208 358.728583 $17936.4700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 24 25 50.141272 $2507.0700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 141 169 255.178977 $12758.9900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 27 32 46.999999 $2350.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.033333 $25.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 289 342 500.575784 $25028.8800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 58 72 110.911109 $5545.5400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 371 453 3494.955538 $174748.0400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 37 40 271.938098 $13596.9100 $50.0000
INTR -T1013 INTERPRETER 2 2 4.000000 $200.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 74 90 655.876193 $46855.8500 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 26.285714 $1877.8600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 8.923810 $637.5200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 64 80 614.314285 $43886.6400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 13.428571 $767.5800 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 3 7.961905 $568.8100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 4.142857 $295.9700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 82 97 669.589289 $47835.4700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 18.433333 $1316.8800 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 10.442857 $746.0400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 38.033333 $2717.1100 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 14.000000 $194.3200 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 6.571429 $243.1400 $37.0000
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Subtotal (Total Children Is Unduplicated) 501 2207 8053.104928 $491503.4900 $61.0300
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Total 2796 8804.230742 $535402.5900 $60.8100
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Number of Children (Unduplicated) With at Least One Authorization 575