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: 07-01-15 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 5036 FSPSA's found of which 242 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
CASE -CASE NON-TCM CASE MANAGEMENT 2 4 3.142857 $116.2900 $37.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 15 23 182.591669 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 27 185.734526 $116.2900 $0.6300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 6 281.611111 $13658.1400 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.277778 $13.3100 $10.4200
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.283333 $13.2600 $46.7900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.283333 $33.8800 $119.5900
EVAL -96111 DEVELOPMENTAL EVALUATION 2 4 10.000000 $500.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 17 17 42.707718 $2135.3900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 8 4.011111 $300.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 35 41 27.919844 $2094.0100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 24 34 15.244442 $1143.3200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 26 29 13.855557 $768.9900 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.500000 $83.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 5 3.055556 $229.1700 $75.0000
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 11 14 5.282876 $792.4200 $150.0000
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 12.466667 $636.4300 $51.0500
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Subtotal (Total Children Is Unduplicated) 100 163 419.499326 $22402.4000 $53.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 6 68.316666 $341583.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 2.238888 $111.9400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 96 101 91.984299 $4599.2100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.772222 $55.3000 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 111 156 721.059557 $36052.9900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 8 4.477779 $111.9500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 348 649 1462.150804 $73107.5900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 41 56 123.922220 $3098.0500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 7 18.187301 $1333.4900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 13.014287 $325.3600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 64 87 528.180842 $26409.0600 $50.0000
INTR -T1013 INTERPRETER 1 1 8.000000 $400.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 811 2005 16875.555541 $168755.5900 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.705556 $45.8600 $65.0000
SENS -V5264 EARMOLD 1 1 0.283333 $5.1000 $18.0000
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 574 1745 10199.769846 $5099.8800 $0.5000
TRAV -TRAVS Travel by mile 11 15 4706.813319 $2094.5300 $0.4500
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Subtotal (Total Children Is Unduplicated) 1045 4846 34825.432460 $663188.8800 $19.0400
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Total 5036 35430.666312 $685707.5600 $19.3500
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Number of Children (Unduplicated) With at Least One Authorization 1048