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 4559 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 157 181 9406.920631 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 7 9 5609.000000 $208654.8000 $37.2000
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Subtotal (Total Children Is Unduplicated) 164 190 15015.920631 $208654.8000 $13.9000
Screening, Eval, and Assessment, Class # 02
EVAL -96111 DEVELOPMENTAL EVALUATION 87 113 166.402892 $8320.1500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 19 23 34.118873 $1705.9500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 42 42 79.033333 $3951.6700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 8 8 16.000000 $1200.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC 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 46 46 92.000000 $6900.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 7 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 12 12 24.000000 $1800.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 21 21 42.000000 $3150.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 7 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 20 20 40.000000 $2220.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 9 12 6.655556 $342.1600 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 15 18 18.488891 $950.5200 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 2.027778 $104.2500 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 6 9 4.827778 $248.2000 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.588889 $30.2800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 4 2.350000 $120.8100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 5.011111 $257.6200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 18 20 9.727778 $500.1100 $51.4100
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Subtotal (Total Children Is Unduplicated) 244 388 608.232879 $36419.1200 $59.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 6 6.633333 $33166.5000 $4999.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 3 2.366667 $118.3400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.400000 $92.6500 $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 25 37 652.714284 $32635.7100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 29.428571 $1471.4300 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 27 418.797618 $30136.6900 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 22 32 587.714284 $33852.3300 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 52.285714 $3011.6600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 10 17 309.142858 $22245.9300 $71.9600
PHY -97110HM PT SESSION BY PT ASST 8 14 240.142857 $13822.6300 $57.5600
SENS -V5264 EARMOLD 1 1 0.800000 $14.5000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 29 39 536.214282 $38586.0000 $71.9600
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Subtotal (Total Children Is Unduplicated) 701 3981 9445.141275 $453815.4600 $48.0500
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Total 4559 25069.294785 $698889.3800 $27.8800
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Number of Children (Unduplicated) With at Least One Authorization 874