Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 04-01-16 and 06-30-16 Date of Report: 08-06-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3156 FSPSA's found of which 2 had no frequency modifier field, FORCE FREQ MODIFIER to 0
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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 9 14 55.092858 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 14 55.092858 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 3.622222 $175.6800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.794445 $37.4100 $47.0900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.011111 $10.5400 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 32 34 18.734130 $411.2200 $21.9500
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.377779 $89.7600 $65.1500
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.005556 $0.2100 $38.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.022223 $94.6400 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.516667 $181.4000 $119.6000
EXIT -EXIT EXIT ASSESSMENT 6 6 8.333333 $416.6700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 6 6.900000 $517.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 18 17.972225 $1347.9400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 52 71 69.731286 $5229.9000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 4.200001 $315.0100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 32 35 38.644450 $2898.3800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 89 116 108.084467 $5998.7600 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 36 36 71.516667 $3969.1800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 13.538889 $1015.4200 $75.0000
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 1.533333 $78.2800 $51.0500
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Subtotal (Total Children Is Unduplicated) 183 350 369.538784 $22787.8700 $61.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 11 6.144444 $30722.0000 $4999.9600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 1.733334 $86.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 79 80 41.260449 $2063.0900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.638889 $45.7500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 1.679659 $401.7800 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 52 67 315.809990 $15790.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 2.694445 $67.3600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 273 401 602.433346 $30121.7300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 33 47 56.938887 $1423.4700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 12 13 44.009523 $3226.7800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 22 22 134.757144 $3368.9300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 641 893 5759.059513 $287953.1000 $50.0000
INTR -T1013 INTERPRETER 1 1 6.857143 $342.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 654 1235 6365.246826 $63652.5000 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.505556 $32.8600 $65.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.011111 $239.7500 $237.1200
SENS -V5264 EARMOLD 2 2 2.527778 $45.5000 $18.0000
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Subtotal (Total Children Is Unduplicated) 671 2791 13343.308037 $439584.6300 $32.9400
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Total 3155 13767.939679 $462372.5000 $33.5800
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Number of Children (Unduplicated) With at Least One Authorization 673