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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1882 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 61 65 2768.209522 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 1420.000000 $52824.0000 $37.2000
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Subtotal (Total Children Is Unduplicated) 64 68 4188.209522 $52824.0000 $12.6100
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 28 34 39.694826 $1984.7400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 8 9 12.723288 $636.1700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 13 13 25.000000 $1250.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.800000 $41.1300 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 8 6.244444 $321.0200 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.2800 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.077778 $4.0000 $51.4200
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 1.933333 $99.3900 $51.4100
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Subtotal (Total Children Is Unduplicated) 73 100 137.984780 $8047.1300 $58.3200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.188889 $944.5000 $5000.2900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.488889 $24.4500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 25 16.038889 $801.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 14.333333 $358.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 251 321 257.011102 $12850.5100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 1.188889 $59.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 135 169 282.270638 $7056.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 138 305 189.191651 $9459.5100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 2 1.644444 $82.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 65 157 186.266657 $4656.6400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 150 91.588876 $4579.3800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 32 83 120.422221 $3010.5500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 226 273 224.542054 $11227.0600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 1.188889 $59.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 129 157 235.766671 $5894.1800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13 15 131.999998 $6600.0200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 8 60.428572 $4348.4400 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 10 12 123.428571 $7109.4900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 3 4 39.428571 $2837.2900 $71.9600
PHY -97110HM PT SESSION BY PT ASST 5 5 58.428571 $3363.1600 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 15 131.285714 $9447.3300 $71.9600
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Subtotal (Total Children Is Unduplicated) 395 1714 2167.132089 $94770.6500 $43.7300
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Total 1882 6493.326391 $155641.7900 $23.9700
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Number of Children (Unduplicated) With at Least One Authorization 474