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: 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 3065 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 0.511111 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 11 12 36.198412 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 14 36.709523 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.227778 $10.7300 $47.0900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.172222 $3.3100 $19.2000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 92 98 79.051585 $1735.1800 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 14.087301 $123.2600 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.511111 $11.1600 $21.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.366667 $9.3600 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 2.766666 $129.4800 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 3.022222 $361.4600 $119.6000
EXIT -EXIT EXIT ASSESSMENT 6 6 125.238096 $6261.9100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.227778 $17.0900 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 23 39 22.761110 $1707.0800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 43 73 48.573437 $3642.9800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.216667 $16.2500 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 15 19 17.764285 $1332.3200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 62 110 89.463121 $4965.1900 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 16 16 23.450793 $1301.5300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 4.511111 $338.3300 $75.0000
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Subtotal (Total Children Is Unduplicated) 174 383 433.411950 $22015.0900 $50.7900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 10 6.655555 $33277.5000 $4999.9600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.244444 $62.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 18 5.938889 $296.9500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.538889 $38.5900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 24 25 14.646031 $3503.3000 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 39 47 131.044446 $6552.2300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 3.166667 $79.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 242 351 509.040476 $25452.0300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 18 24 22.049999 $551.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 5.533334 $276.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 3.133334 $156.6700 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 15 20 58.238889 $4270.0800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 18 22 95.884125 $2397.1100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 684 903 5754.680152 $287734.0400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 684 1226 6381.469044 $63814.7000 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.233333 $15.1600 $64.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.466667 $110.6600 $237.1400
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 1.511111 $716.6200 $474.2400
SENS -V5264 EARMOLD 3 3 2.466666 $44.4000 $18.0000
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Subtotal (Total Children Is Unduplicated) 693 2668 12997.942051 $429349.3400 $33.0300
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Total 3065 13468.063524 $451364.4300 $33.5100
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Number of Children (Unduplicated) With at Least One Authorization 695