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: 07-01-16 and 09-30-16 Date of Report: 10-26-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1987 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 2 2 0.266667 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 12 13 66.911905 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 15 67.178572 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.744444 $7.7600 $10.4200
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.677778 $133.8900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 6 6 6.844444 $342.2200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 3.488889 $261.6700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 21 21 8.350000 $626.2500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 6 6 1.588889 $119.1700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 32 32 13.366665 $741.8400 $55.5000
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Subtotal (Total Children Is Unduplicated) 43 78 38.061109 $2281.2900 $59.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 2 2.022222 $10111.0000 $4999.9500
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 1.538888 $76.9400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 52 52 23.788397 $1189.4000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 6.071429 $434.7700 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 54 58 313.888891 $15694.4600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 3.022222 $75.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 269 412 639.269041 $31963.4200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 27 37 49.033331 $1225.8300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 4.416667 $323.8300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.933333 $48.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 6 45.528571 $2276.4300 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 670 1312 6460.761090 $64607.6500 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.311111 $20.2200 $65.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 1.261111 $598.0600 $474.2400
TRAV -TRAVS Travel by mile 1 1 3.642857 $1.6200 $0.4500
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Subtotal (Total Children Is Unduplicated) 674 1894 7558.489161 $128747.5200 $17.0300
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Total 1987 7663.728842 $131028.8100 $17.1000
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Number of Children (Unduplicated) With at Least One Authorization 678