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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2772 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 53 60 83.253969 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 53 60 83.253969 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 9 10 15.353424 $1151.5100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 9 9 14.500000 $1087.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 6 6 10.011111 $750.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 14 14 23.500000 $1304.2500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 10 10 14.159056 $785.8200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 12 12 24.000000 $1800.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 41 41 74.175342 $5563.1600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 10.500000 $787.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 31 31 60.500000 $4537.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 24 24 44.000000 $3300.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 42 42 81.000000 $6075.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 60 61 119.000000 $6604.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 65 66 117.675342 $6530.9800 $55.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 24 26 15.313165 $787.2500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 2.794445 $143.6700 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.461111 $23.7100 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 37 39 16.746195 $860.9300 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 3 3 1.455556 $74.8300 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 13 17 14.327778 $736.5900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 14 9.774277 $502.5000 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 1.161644 $59.7200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 9 9 4.833484 $248.4900 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 6.000000 $308.4600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 34 40 16.965982 $872.2200 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.272222 $65.4000 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 6.571429 $347.8200 $52.9300
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Subtotal (Total Children Is Unduplicated) 280 512 730.051563 $46962.0500 $64.3300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 14 11.517808 $57589.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 45 53.878572 $2693.9400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 18 22 26.311903 $1315.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 6.000000 $150.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 330 413 557.222217 $27861.1100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 90 112 159.915869 $7995.7900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.011111 $0.2800 $24.9800
CONOF -CONOF CONSULT, OT, FACE TO FACE 133 165 217.059524 $10852.9800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 78 94 131.989683 $6599.4900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.988889 $24.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 97 138 137.773015 $6888.6600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 46 68 53.409522 $2670.4700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 196 252 299.924996 $14996.2400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 98 123 166.673808 $8333.6900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.900000 $47.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.533333 $38.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 73.000000 $3650.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 353 464 3294.932318 $164746.4900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 63 78 523.176183 $26158.8200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4 5 28.285714 $282.8600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 39 49 313.242857 $22540.9400 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 3 14.961904 $1076.6600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 14.428572 $1038.2800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 34 50 298.752379 $21498.2400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 7 9 42.785712 $3078.8700 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 6.671429 $480.0700 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 3 14.066667 $1012.2400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 40 56 288.415077 $20754.3500 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 6 35.571429 $2559.7200 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 26.285714 $1891.5200 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $164.4800 $71.9600
TRAV -TRAVS Travel by mile 3 4 62.428571 $27.7800 $0.4400
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Subtotal (Total Children Is Unduplicated) 441 2200 6865.400490 $419019.0800 $61.0300
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Total 2772 7678.706022 $465981.1300 $60.6800
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Number of Children (Unduplicated) With at Least One Authorization 528