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: 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 1981 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 68 75 1848.699997 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 1654.000000 $61528.8000 $37.2000
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Subtotal (Total Children Is Unduplicated) 72 79 3502.699997 $61528.8000 $17.5700
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 19 21 31.042542 $1552.1300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 4 4.568797 $228.4400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 10 10 18.300000 $915.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 17 17 34.000000 $2550.0000 $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 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $777.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 7 7 2.466667 $126.8100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 11 7.238889 $372.1500 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 1.500000 $77.1200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.500000 $77.1200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.877778 $45.1300 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 1.916666 $98.5300 $51.4100
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Subtotal (Total Children Is Unduplicated) 77 114 161.411339 $10041.4200 $62.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.000000 $10000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 18 18 12.900001 $645.0100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 4 4.000000 $200.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 5 3.033334 $75.8400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 253 338 234.848410 $11742.4100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 0.650000 $32.5000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 137 173 265.071431 $6626.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 156 345 210.303965 $10515.1900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 5 3.822222 $191.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 63 139 193.622214 $4840.5400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 133 82.572224 $4128.6200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 32 70 110.205555 $2755.1400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 230 292 205.205559 $10260.3000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 0.422222 $21.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 134 164 239.927778 $5998.2000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 5.571429 $278.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16 21 164.000001 $8200.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 13 95.107144 $6843.9000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 18 21 193.428573 $11141.4600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 7 9 80.714285 $5808.2100 $71.9600
PHY -97110HM PT SESSION BY PT ASST 7 9 76.571427 $4407.4600 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 19 21 139.857146 $10064.1000 $71.9600
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Subtotal (Total Children Is Unduplicated) 409 1788 2323.834920 $114776.4200 $49.3900
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Total 1981 5987.946256 $186346.6500 $31.1200
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Number of Children (Unduplicated) With at Least One Authorization 476