Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 8716 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
CASE -CASE NON-TCM CASE MANAGEMENT 4 4 13.533333 $500.7300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 123 144 464.223010 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 126 148 477.756343 $500.7300 $1.0500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 42 52 81.128962 $3934.7500 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $23.5000 $23.5000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 4.000000 $339.3600 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 2.000000 $41.7800 $20.8900
EXIT -EXIT EXIT ASSESSMENT 26 26 52.000000 $2600.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 10 20.000000 $1110.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 159 161 329.642857 $24723.2100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 23 23 45.000000 $3375.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 91 91 176.500000 $13237.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 7 7 13.500000 $1012.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 322 325 643.142857 $35694.4300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 17 17 34.000000 $1887.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 153 163 312.928571 $23469.6500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 16 16 31.500000 $2362.5000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 6 9.857143 $503.2100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 4.000000 $204.2000 $51.0500
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 4.000000 $204.2000 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 13 12.068493 $616.1000 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 0.421918 $21.5400 $51.0600
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $133.6500 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 0.221918 $9.8900 $44.5700
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 9 9 53.555555 $2815.4200 $52.5700
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Subtotal (Total Children Is Unduplicated) 533 986 1908.468274 $123546.1200 $64.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 36 44 70.741292 $353707.0000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 7 7.000000 $350.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 13.857143 $954.2000 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 25 25 31.285714 $7195.7100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 239 266 316.389498 $15819.4700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 10 16 1.557535 $77.8700 $49.9900
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 37 38 43.829290 $1095.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 212 276 598.088889 $29904.4500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 26 30 63.577777 $3178.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 6 16.000000 $400.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 79 93 174.989677 $8749.4600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 7 7 15.977778 $798.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 18.519047 $462.9800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 93 119 267.292855 $13364.6400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 11 13 22.666666 $1133.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 6 6 15.399999 $385.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 143 184 395.947620 $19797.3900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 17 21 32.477778 $1623.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 17.366667 $434.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 10 10 7.466665 $373.3500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1194 1549 12120.733332 $606036.0400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 57 72 394.023811 $19701.1700 $50.0000
INTR -T1013 INTERPRETER 126 152 614.064285 $30703.2100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1328 2153 15371.253756 $153712.4000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 37 47 322.814287 $23061.8400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 18.857143 $1347.1500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 104 133 1026.647630 $73343.6200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 4 34.714285 $2479.9900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 10 13 138.714287 $9909.7300 $71.4400
SENS -V5264 EARMOLD 1 1 2.000000 $36.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 80 99 766.323809 $54746.1600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 3 25.714285 $1837.0300 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.000000 $71.4400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 10 11 85.428571 $6103.0100 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 8 10 74.571429 $1035.0500 $13.8800
TRAV -TRAVS Travel by mile 1334 2160 15375.058518 $6841.8900 $0.4400
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Subtotal (Total Children Is Unduplicated) 1409 7582 48502.351318 $1450772.1000 $29.9100
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Total 8716 50888.575935 $1574818.9600 $30.9500
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Number of Children (Unduplicated) With at Least One Authorization 1562