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 1920 FSPSA's found of which 1 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
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.011111 $10.5400 $10.4200
EXIT -EXIT EXIT ASSESSMENT 6 6 8.333333 $416.6700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.322222 $24.1700 $74.9900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 14 14 5.116670 $383.7800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.338889 $25.4200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 18 5.861115 $325.3100 $55.5000
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) 30 47 26.138895 $1439.8200 $55.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 2 1.344444 $6722.0000 $4999.8400
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
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 1 1 1.733333 $127.0900 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16 17 58.943649 $2947.1900 $50.0000
INTR -T1013 INTERPRETER 1 1 6.857143 $342.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 654 1234 6363.746826 $63637.5000 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.505556 $32.8600 $65.0100
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Subtotal (Total Children Is Unduplicated) 660 1858 7454.001402 $123362.3100 $16.5500
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Total 1919 7535.233155 $124802.1300 $16.5600
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Number of Children (Unduplicated) With at Least One Authorization 663