Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 5756 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 84 92 430.438093 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 4 17.571429 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 84 96 448.009522 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 19 26 53.511731 $2595.3300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.032877 $1.5500 $47.1200
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.285714 $19.2000 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.285714 $24.6900 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.285714 $13.4000 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.285714 $28.2200 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.285714 $11.2500 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.285714 $10.3600 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.285714 $28.0800 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.285714 $37.1600 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.285714 $83.7500 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.474603 $37.6500 $25.5300
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 113 116 232.000000 $11600.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.002740 $0.1500 $54.6700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 13.500000 $1012.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.500000 $412.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $777.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 2 3.000000 $225.0000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 3.285714 $164.2900 $50.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 2.000000 $102.1000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 4.181888 $213.4900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 150 185 352.060979 $17900.7900 $50.8500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 2.844444 $14222.0000 $4999.9200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 20 20 478.919840 $23945.9900 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 179 202 237.718503 $11885.9100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 5.450000 $136.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 159 248 708.866403 $35443.3700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 2.733334 $68.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 26 33 195.587300 $9779.3500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 72 209.199823 $10460.0300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 80 93 214.557148 $10727.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 9.428571 $235.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 31 38 276.261902 $13813.1000 $50.0000
INTR -T1013 INTERPRETER 78 97 531.478767 $26573.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1282 2236 15294.869387 $152948.8000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 35.714286 $2551.4300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 8 10 94.066666 $6720.1300 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.022222 $66.4400 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 23 153.495240 $10965.7000 $71.4400
TRAV -TRAVS Travel by mile 1312 2387 42403.206235 $18869.4300 $0.4500
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Subtotal (Total Children Is Unduplicated) 1325 5475 60855.420071 $349413.7900 $5.7400
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Total 5756 61655.490572 $367314.5800 $5.9600
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Number of Children (Unduplicated) With at Least One Authorization 1382