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: 10-01-23 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 3670 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 91 93 5112.822220 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 114 125 36922.872221 $1373530.8400 $37.2000
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Subtotal (Total Children Is Unduplicated) 204 218 42035.694441 $1373530.8400 $32.6800
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 0.622223 $31.1200 $50.0100
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 4 7.000000 $350.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 8 15.000000 $1125.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 22 24 39.155556 $2936.6700 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 6.005479 $450.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $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 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 2.131812 $159.8900 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 19 36.966667 $2051.6500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 193 197 392.000000 $29400.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 24 24 47.000000 $3525.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 33 33 66.000000 $4950.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 45 45 90.000000 $6750.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 10 10 19.000000 $1425.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 105 105 208.000000 $11544.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 22 22 44.000000 $2442.0000 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 79 99 34.229758 $1759.7600 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 3 3 -0.094444 $-4.8500 $51.3900
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 1.022222 $52.5500 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 2.605555 $133.9500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 10 3.705557 $190.5100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 86 96 87.686507 $4507.9600 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 5 5 3.266666 $167.9400 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 43 53 18.688814 $960.8000 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 3 3 0.350000 $17.9900 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 4 2.172222 $111.6700 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 18 18 10.846043 $557.5900 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.127778 $6.5700 $51.4200
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.350000 $17.9900 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 17 17 8.533332 $438.6900 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.122222 $6.2800 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 150 179 78.157311 $4018.0400 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.077778 $55.4100 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 6 7 3.050000 $156.8000 $51.4100
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Subtotal (Total Children Is Unduplicated) 564 1032 1274.779058 $83574.0400 $65.5600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 5.238889 $26194.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 23 23 18.244444 $912.2200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 2 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 9.227778 $230.7000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 251 305 219.288080 $10964.3300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 3 2.077777 $103.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 116 137 188.522227 $4713.0700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 173 324 216.788880 $10839.4000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 4 4.022222 $201.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 58 133 179.422214 $4485.5400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 47 106 64.955552 $3247.7600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 21 44 61.277781 $1531.9500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 182 208 142.195224 $7109.7000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 5 5 4.233332 $211.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 122 144 182.833336 $4570.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 261 323 2547.433336 $127371.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 16 16 115.757143 $5787.8700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 104 133 1112.080154 $80025.3400 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 4 39.428571 $2837.2800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 106 126 1371.142853 $78977.8700 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 3 3 12.857143 $740.5700 $57.6000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 1.428571 $82.2900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 51 62 496.319844 $35715.1900 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 11.571429 $832.6800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 50 60 573.495234 $33010.4200 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 7.285714 $419.3600 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 169 216 1820.904758 $131032.4300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 12.428571 $894.3600 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 16 19 162.561906 $11697.9800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 3 19.276190 $1387.1200 $71.9600
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Subtotal (Total Children Is Unduplicated) 603 2420 9617.442010 $587174.9400 $61.0500
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Total 3670 52927.915509 $2044279.8200 $38.6200
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Number of Children (Unduplicated) With at Least One Authorization 836