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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 10401 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 161 185 9547.320631 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 213 242 146019.458729 $5431923.8600 $37.2000
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Subtotal (Total Children Is Unduplicated) 369 427 155566.779360 $5431923.8600 $34.9200
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 89 116 171.369559 $8568.4900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 19 23 34.118873 $1705.9500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 43 43 79.677777 $3983.8900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 9 18.000000 $1350.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 58 59 112.027701 $8402.0800 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 16.000000 $1200.0000 $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 26 26 52.000000 $3900.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 24 24 44.022222 $2443.2300 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 765 775 1541.133334 $115585.0100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 191 193 384.000000 $28800.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 124 124 245.066667 $18380.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 30 30 60.000000 $4500.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 209 209 418.000000 $31350.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 56 56 111.000000 $8325.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 470 475 948.066667 $52617.7000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 103 104 208.000000 $11544.0000 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 180 282 185.083413 $9515.1500 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 5 5 3.166667 $162.8000 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 0.350000 $17.9900 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 10 11 12.066667 $620.3500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 29 43 27.983337 $1438.6400 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.427778 $21.9900 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 199 232 243.256366 $12505.8400 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 17 20 16.511112 $848.8400 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 5 5 7.000000 $359.8700 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 4 5 5.955556 $306.1800 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 91 149 141.938101 $7297.0600 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 5 8 5.505556 $283.0400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 18 10.216667 $525.2400 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 70 87 76.966667 $3956.8600 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 8 9 10.205556 $524.6700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 5 5 5.000000 $257.0500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 27 30 24.116669 $1239.8500 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 3 2.405556 $123.6700 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.533333 $27.4200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 329 476 336.850015 $17317.5400 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 7 3.144444 $161.6500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 7 10 6.155556 $316.4600 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.850000 $43.7000 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.272222 $13.9900 $51.4100
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Subtotal (Total Children Is Unduplicated) 1487 3706 5603.449517 $362962.4800 $64.7700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 10 11.672222 $58361.0000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 3 2.366667 $118.3400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 6 5.911111 $1369.1300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 50 72 54.930561 $2746.5600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 3 8 8.000000 $400.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 12 13 35.052779 $876.3200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 450 722 1003.246032 $50162.3100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 6 4.700001 $235.0100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 262 395 1128.773023 $28219.3500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 293 790 871.144434 $43557.1700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 9 10.944443 $547.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 127 364 822.249997 $20556.2400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 79 285 344.988889 $17249.4500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 41 159 425.500004 $10637.5100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 397 595 861.950796 $43097.5500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 6 6 4.322223 $216.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 256 374 1018.983339 $25474.6000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 11.714286 $585.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 468 774 11765.352350 $588267.7200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 36 48 534.285715 $26714.2900 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 199 321 4520.229356 $325275.8000 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 4 5 64.999999 $4677.4000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 235 395 7484.742050 $431121.1700 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 7 7 121.142857 $6977.8300 $57.6000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.344444 $24.7800 $71.9500
OCCT -97530TLHM OT SESSION BY OT ASST 2 3 136.571428 $7866.5200 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 93 161 2425.790473 $174559.9100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 4 69.857143 $5026.9200 $71.9600
PHY -97110HM PT SESSION BY PT ASST 83 173 3167.163487 $182301.9700 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 17.571429 $1011.4100 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 24.571429 $1768.1600 $71.9600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 16.285714 $937.4000 $57.5600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 4 3.277778 $1505.2300 $459.2200
SENS -V5264 EARMOLD 3 6 6.311111 $114.4200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 313 493 6969.541254 $501528.2900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 8 10 138.142855 $9940.7600 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 21 33 545.057142 $39222.3200 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 7 55.619047 $4002.3400 $71.9600
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Subtotal (Total Children Is Unduplicated) 1027 6268 44695.307868 $2617354.1900 $58.5600
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Total 10401 205865.536745 $8412240.5300 $40.8600
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Number of Children (Unduplicated) With at Least One Authorization 1629