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 1568 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 -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 0.500000 $37.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 8 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.227778 $11.7100 $51.4100
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Subtotal (Total Children Is Unduplicated) 20 27 44.727778 $3020.8500 $67.5400
EI Services, Class # 03
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 77 93 131.645239 $6582.2700 $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
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 34.000000 $1700.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 13 63.928571 $3196.4300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 6.857142 $342.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4 5 28.285714 $282.8600 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 6 6 24.571428 $1768.1700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 3 12.857142 $925.2000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 3 11.428571 $822.4000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.428571 $318.6800 $71.9600
TRAV -TRAVS Travel by mile 3 4 62.428571 $27.7800 $0.4400
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Subtotal (Total Children Is Unduplicated) 392 1481 2061.500375 $99797.5900 $48.4100
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Total 1568 2189.482122 $102818.4400 $46.9600
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Number of Children (Unduplicated) With at Least One Authorization 439