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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2532 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 33 34 45.611111 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.011111 $0.4100 $37.1600
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Subtotal (Total Children Is Unduplicated) 34 35 45.622222 $0.4100 $0.0100
Screening, Eval, and Assessment, Class # 02
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 6.611111 $495.8300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.022222 $151.6700 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 0.005556 $0.4200 $75.5900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 14 15 23.522222 $1305.4800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 42 42 80.505479 $6037.9100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 36 36 71.000000 $5325.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 33 33 66.000000 $4950.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 39 39 78.000000 $5850.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 18 18 35.500000 $2662.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 49 49 106.648336 $5918.9900 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 55 56 109.500000 $6077.2500 $55.5000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 21 23 10.258371 $527.3800 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.394444 $20.2800 $51.4000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 1.161111 $59.6900 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 8 9 2.483104 $127.6500 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 2 2.000000 $102.8200 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 4 4 0.888433 $45.6800 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 14 15 12.122222 $623.2000 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.888889 $45.7000 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.066667 $3.4300 $51.4300
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 3.550000 $182.5100 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 4 4 2.561111 $131.6700 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 19 20 17.452435 $897.2300 $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 2 2 1.494444 $76.8300 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 17 17 7.066667 $363.3000 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.266667 $13.7100 $51.4200
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 4 19.714286 $1013.5100 $51.4100
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Subtotal (Total Children Is Unduplicated) 236 441 711.194888 $46303.5900 $65.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 14 25.394912 $126975.0000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 35 42 36.755555 $1837.7800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 12 15 13.644444 $682.2200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 334 409 683.812588 $34190.6100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 95 110 176.646828 $8832.3500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 127 155 193.152381 $9657.6100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 96 109 193.018258 $9650.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.142857 $53.5700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 109 131 215.169450 $10758.4800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 46 53 82.537700 $4126.8800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 171 205 335.031349 $16751.5200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 86 99 148.859921 $7442.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 5.011110 $125.2800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 5 8.133333 $203.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 9 75.214286 $3760.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 359 445 3261.855563 $163092.9600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 72 83 599.561905 $29978.1400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 38 47 325.301588 $23408.7500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 4 6 33.368255 $2401.1900 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 38 52 352.928571 $25396.7600 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 7 7 46.785714 $3366.7100 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 3 3 16.142858 $1161.6400 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 13.142857 $945.7600 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 38 44 303.542862 $21842.9600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 6 38.857144 $2796.1600 $71.9600
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Subtotal (Total Children Is Unduplicated) 448 2056 7200.155146 $510411.0100 $70.8900
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Total 2532 7956.972256 $556715.0200 $69.9700
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Number of Children (Unduplicated) With at Least One Authorization 551